Buttock Claudication, an uncommon form of intermittent claudication: a narrative review of its rehabilitative management

Background: Buttock claudication is an uncommon but disabling manifestation of peripheral arterial disease, caused by stenosis or occlusion of the internal iliac artery. It results in exertional buttock pain and impaired ambulation. Diagnosis is often challenging, since symptoms overlap with orthopedic and neurological conditions, frequently delaying appropriate management. While revascularization remains the standard of care, conservative treatments are required when surgical management is not feasible or indicated. Objective: To review and synthesize the available evidence on conservative treatment approaches for buttock claudication, with a focus on rehabilitative strategies. Methods: A narrative review of the literature was conducted. Studies investigating non-surgical treatment of buttock claudication were identified, with emphasis on exercise therapy, pharmacological interventions, and risk factor modification. Results: The review identified a critical paucity of evidence specific to conservative management of buttock claudication. No published studies explicitly investigated rehabilitative protocols or structured exercise interventions in this population. Available data are limited to extrapolations from distal peripheral arterial disease, where supervised exercise therapy, cardiovascular risk factor modification, and pharmacological optimization (e.g., antiplatelet agents, statins, vasodilators) have demonstrated efficacy. Based on these findings, a preliminary conceptual framework for conservative care in buttock claudication is proposed. Conclusion: Evidence supporting conservative treatment of buttock claudication is virtually absent. Dedicated clinical studies are urgently needed to establish and validate rehabilitation-oriented protocols and optimize non-invasive management strategies for this condition.