ABC of vascular diseases. The young patient with claudication.

All patients with intermittent claudication merit careful assessment, but the young claudicant patient in particular has much to gain from investigation, not only because an easily treatable lesion may be found but also because the Causes of intermittent claudication long term outlook may be improved if risk factors are recognised and * Atherosclerosis treated. * Thromboembolism Most patients with intermittent claudication present at between 55 and * Buerger's disease 60 years ofage, when the commonest cause is progression ofatherosclerosis. * Arteritis: In younger patients the other causes ofclaudication are proportionally more Systemic lupus erythematosus common. In this article we consider the patient who presents under the age Takayasu's disease of 50. * Fibrosis: A conservative approach is often appropriate for the older claudicant Retroperitoneal patient, particularly if clinical examination suggests a superficial femoral Radiation * Developmental anomalies: artery occlusion. Exercise, giving up smoking, and changes in the diet can Coarctation be effective, and the natural history of intermittent claudication is that only Persistent sciatic artery about a quarter ofpatients continue to deteriorate. This conservative course Popliteal entrapment is not appropriate for the young claudicant patient, in whom the symptoms * Trauma more dramatically affect lifestyle, unusual diagnoses assume greater * Cystic adventitial disease importance, and thorough investigation of the arterial system should be encouraged. Extensive non-invasive investigation is now possible and less invasive methods of treatment are more accepted.