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* The false-positive diagnosis rates of peripheral arterial disease are estimated to be around 44% and the false-negative rates are estimated be around 19%. | * The false-positive diagnosis rates of peripheral arterial disease are estimated to be around 44% and the false-negative rates are estimated be around 19%. | ||
== Differentiating Peripheral | == Differentiating Peripheral Arterial Disease from Other Diseases == | ||
* Patients with peripheral arterial disease can be asymptomatic, can have symptoms of intermittent claudication or can sometimes have critical symptoms that include ulceration and gangrene. This diversity of presentation, as well as the spectrum of severity of symptoms with which patients present, lead to the presence of a long list of differential diagnosis. | * Patients with peripheral arterial disease can be asymptomatic, can have symptoms of intermittent claudication or can sometimes have critical symptoms that include ulceration and gangrene. This diversity of presentation, as well as the spectrum of severity of symptoms with which patients present, lead to the presence of a long list of differential diagnosis. | ||
* Most importantly, '''[[claudication]]''' caused by the peripheral arterial disease must be differentiated from the '''pseudoclaudication''' caused by '''[[lumbar spinal stenosis]]'''<ref name="Spittel">Spittel P. Chapter 44. Peripheral vascular Disease. In Murphy J, Lloyd M,Mayo Clinic Cardiology Concise Textbook. Fourth edition.Mayo clinic scientific press.2013</ref>. | * Most importantly, '''[[claudication]]''' caused by the peripheral arterial disease must be differentiated from the '''pseudoclaudication''' caused by '''[[lumbar spinal stenosis]]'''<ref name="Spittel">Spittel P. Chapter 44. Peripheral vascular Disease. In Murphy J, Lloyd M,Mayo Clinic Cardiology Concise Textbook. Fourth edition.Mayo clinic scientific press.2013</ref>. | ||
Revision as of 20:54, 30 October 2012
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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
- Patients with peripheral arterial disease can be asymptomatic, can have symptoms of intermittent claudication or can sometimes have critical symptoms that include ulceration and gangrene. This diversity of presentation, as well as the spectrum of severity of symptoms with which patients present, lead to the presence of a long list of differential diagnosis.
- The most important differential diagnosis of claudication caused by the peripheral arterial disease is pseudoclaudication caused by lumbar spinal stenosis[1].
- Intermittent claudication (IC) must be differentiated from lower extremity pain caused by nonvascular etiologies that may include neurologic, musculoskeletal and venous pathologies.
- The false-positive diagnosis rates of peripheral arterial disease are estimated to be around 44% and the false-negative rates are estimated be around 19%.
Differentiating Peripheral Arterial Disease from Other Diseases
- Patients with peripheral arterial disease can be asymptomatic, can have symptoms of intermittent claudication or can sometimes have critical symptoms that include ulceration and gangrene. This diversity of presentation, as well as the spectrum of severity of symptoms with which patients present, lead to the presence of a long list of differential diagnosis.
- Most importantly, claudication caused by the peripheral arterial disease must be differentiated from the pseudoclaudication caused by lumbar spinal stenosis[1].
- 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
Differential Diagnosis
In alphabetical order[2]
- Arteritis (Takayasu, giant cell)
- Aortic coarctation
- Aortic dissection
- Atherosclerosis obliterans
- Baker cyst
- Chronic compartment syndrome
- Cystic adventitial disease
- Deconditioning
- Degenerative joint disease (hip, back, knee)
- Embolic disease
- Fibromuscular dysplasia
- Myopathy
- Popliteal artery entrapment syndrome
- Retroperitoneal fibrosis
- Spinal stenosis
- Thromboangiitis obliterans
- Venous claudication
References
- ↑ 1.0 1.1 Spittel P. Chapter 44. Peripheral vascular Disease. In Murphy J, Lloyd M,Mayo Clinic Cardiology Concise Textbook. Fourth edition.Mayo clinic scientific press.2013
- ↑ Wennberg PW, Rooke TW. Chapter 109. Diagnosis and Management of Diseases of the Peripheral Arteries and Veins. In: Fuster V, Walsh RA, Harrington RA, eds. Hurst's The Heart. 13th ed. New York: McGraw-Hill; 2011.