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Peripheral Arterial Occlusive Disease: Differential Diagnoses & Workup
Updated: Oct 26, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Buerger Disease (Thromboangiitis
Obliterans) | Spinal Stenosis |
| Chronic Venous Insufficiency | Varicose Veins |
| Compartment Syndrome, Lower Extremity | |
| Degenerative Disk Disease | |
| Osteoarthritis |
Other Problems to Be Considered
Some disease processes mimic claudication symptoms and must be excluded. They include the following:
- Osteoarthritis: This is associated with arthritic pain that is variable from day to day and may be aggravated by certain weather patterns or movements. Rest does not relieve pain.
- Venous disease: Described as a dull, aching pain that typically occurs at the end of the day or after prolonged standing, venous disease is not exacerbated by exercise.
- Neurospinal disease: Pain occurs in the morning and is not relieved by short resting periods. Neurospinal pain is frequently relieved by leaning forward against a solid surface or by sitting.
- Chronic compartment syndrome: This is rare. It is usually observed in runners and other athletes with large, developed calf muscles. Muscles swell during activity, leading to increased compartment pressure and decreased venous return. Consistent with claudication pain, this pain occurs with exercise and is relieved with rest. However, the type of exercise is at a more strenuous level and the recovery period is prolonged.
- Popliteal entrapment syndrome: This syndrome is similar to intermittent claudication but is usually observed in active young people. The syndrome is caused by various abnormal anatomical configurations of the insertion of the medial gastrocnemius muscle head, which causes compression of the popliteal artery. Upon physical examination, tibial pulses may disappear when the knee is at full extension. Pain is aggravated with walking but not with running because knee extension is not as severe with running.
- Reflex sympathetic dystrophy or minor causalgia: This is characteristically described as a burning pain. The superficial pain is often distributed along a somatic nerve and is often related to a past trauma in the extremity.
- Diabetic neuropathy: Pain is due to a peripheral neuritis. Differentiation from intermittent claudication can be difficult because of accompanying skin discoloration and diminished pulses. An extensive neurologic evaluation is essential.
- Venous thrombosis: Swelling and leg pain occur with walking. Pain is relieved by extremity elevation, which distinguishes this entity from arterial insufficiency.
Workup
Laboratory Studies
A laboratory workup is only helpful for identifying accompanying silent alterations in renal function and elevated lipid profiles.
Imaging Studies
- Angiography still remains the criterion standard arterial imaging study used in the diagnosis of PAOD (see Image 2). However, this test is usually reserved for when an intervention (either endovascular or traditional open surgery) is planned.
- Monaco et al examined the effects of systematic (routine) coronary angiography on patients undergoing surgical treatment of peripheral arterial disease.2 Patients undergoing vascular surgery have a high-risk for cardiovascular complications and mortality. The authors found that routine coronary angiography had a positive impact compared with selectively determining if coronary angiography was needed. The routine coronary angiography improved survival (P=0.01) and no reports of death or cardiovascular events (P=0.003) occurred compared with those patients who were selectively chosen to have coronary angiography prior to vascular surgery. The authors recommend that multicenter trials confirm this finding in a larger population.
Peripheral arterial occlusive disease. This angiogram shows a superficial femoral artery occlusion on one side (with reconstitution of the suprageniculate popliteal artery) and superficial femoral artery stenosis on the other side. This is the most common area for peripheral vascular disease.
- Magnetic resonance angiography (MRA) is useful for imaging large and small vessels. Although MRA was initially felt to provide inadequate images, this is no longer the case. With improved imaging capabilities, MRA can be used to not only diagnose but to help plan the type of indicated intervention.
- Computerized tomographic angiography is another modality used to image arterial disease. Unfortunately, the study still requires a large amount of contrast media and requires an upgraded CT scanner to reconstruct helpful images.
- Duplex ultrasonography is a method of evaluating the status of a patient’s vascular disease. Duplex scanning has the advantage of being noninvasive and requiring no contrast media. Unfortunately, duplex scanning is very technician dependent.
Other Tests
See Physical.
More on Peripheral Arterial Occlusive Disease |
| Overview: Peripheral Arterial Occlusive Disease |
 Differential Diagnoses & Workup: Peripheral Arterial Occlusive Disease |
| Treatment & Medication: Peripheral Arterial Occlusive Disease |
| Follow-up: Peripheral Arterial Occlusive Disease |
| Multimedia: Peripheral Arterial Occlusive Disease |
| References |
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References
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Further Reading
Keywords
peripheral arterial occlusive disease, PAOD, chronic arterial insufficiency, lower extremity claudication, lower extremity ischemia, lower-extremity claudication, lower-extremity ischemia, peripheral vascular disease, cholesterol, smoking, hypertension
