Peripheral arterial disease differential diagnosis
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Peripheral arterial disease Microchapters |
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Differentiating Peripheral arterial disease from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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AHA/ACC Guidelines on Management of Lower Extremity PAD |
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Guidelines for Structured Exercise Therapy for Lower Extremity PAD |
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Guidelines for Minimizing Tissue Loss in Lower Extremity PAD |
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Guidelines for Revascularization of Claudication in Lower Extremity PAD |
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Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD |
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Guidelines for Longitudinal Follow-up for Lower Extremity PAD |
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Peripheral arterial disease differential diagnosis On the Web |
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American Roentgen Ray Society Images of Peripheral arterial disease differential diagnosis |
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Peripheral arterial disease differential diagnosis in the news |
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Directions to Hospitals Treating Peripheral arterial disease |
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Risk calculators and risk factors for Peripheral arterial disease differential diagnosis |
Editors-in-Chief: C. Michael Gibson, M.D., Beth Israel Deaconess Medical Center, Boston, MA; Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Differentiating Peripheral arterial disease from other Diseases
- Intermittent claudication (IC) must be differentiated from lower extremity pain with nonvascular etiologies
- Many concomitant disease processes can complicate the diagnosis of PAD
- Both neurologic and musculoskeletal and venous pathology can cause leg pain or coexist with leg pain from PAD
- False-positive diagnosis rates of up to 44% and false-negative rates of up to 19% have been reported
- Calf claudication is commonly confused with pain from venous disease, nerve root compression or spinal cord stenosis
- Hip and buttock claudication is commonly confused with osteoarthritis of the hip or with spinal canal narrowing due to osteoarthritis
- Nonatherosclerotic conditions that mimic intermittent claudication:
- Venous Claudication
- Occurs in patients with chronic venous insufficiency and those who develop post-thrombotic syndrome after deep venous thrombosis
- Baseline venous hypertension in the obstructed veins worsens with exercise and produces a tight bursting pressure in the limb, usually worse in the thigh and uncommonly in the calf
- Usually associated with evidence of venous edema in the leg
- Venous claudication tends to improve with cessation of exercise, but total resolution takes much longer than resolution of intermittent claudication (IC), and may require leg elevation
- Chronic compartment syndrome
- An uncommon cause of exercise-induced leg pain
- Tends to occur in young athletes, who develop increased pressure within a fixed compartment, compromising perfusion and function of the tissues within that space
- Results from thickened fascia, muscular hypertrophy or when external pressure is applied to the leg
- Presentation is one of tight bursting pressure in the calf or foot following participation in endurance sports or other robust exercise
- Pain subsides slowly with rest
- Intracompartmental pressure testing before and after exercise is the diagnostic test of choice
- Peripheral nerve pain
- Generally attributable to nerve root compression by herniated disks or osteophytes and typically follows the dermatome of the affected root
- Pain usually begins immediately upon walking and may be felt in the calf or lower leg
- Pain is not quickly relieved by rest and may even be present at rest
- A sensation of pain running down the back of the leg as well as a history of back problems may be present
- Spinal chord compression from narrowing secondary to lumbar spine osteoarthritis
- In patients with cauda equina syndrome, upright positioning aggravates the narrowing of the spinal canal, therefore causing symptoms.
- Upright standing may produce pain, weakness or discomfort in the hips, thighs and buttocks, and sometimes a sensation of numbness and paresthesias, although symptoms are usually associated with walking.
- Symptoms are alleviated by sitting or flexing the lumbar spine forward as opposed to standing, which alleviates pain caused by IC.
- Hip and knee osteoarthritis
- Osteoarthritis in joints is typically worse in the morning or at the initiation of movement
- Degree of pain varies day to day, does not cease upon stopping exercise or standing
- Pain improves after sitting, lying down, or leaning against an object to alleviate weight-bearing on the joint.
- Pain may be affected by weather changes, and may be present at rest
- Nonatherosclerotic etiologies of arterial disease:
- Thromboangiitis obliterans
- Popliteal artery entrapment syndrome
- Cystic adventitial disease
- Fibromuscular dysplasia
- Exercise-induced endofibrosis of the iliac arteries
- Other arterial causes of IC or critical limb ischemia
- All of these conditions generally produce a decrease in the exercise or resting ABI
- Usually differentiated from atherosclerotic etiologies by the history and physical examination
- Venous Claudication