Peripheral Arterial Occlusive Disease Differential Diagnoses

Updated: Sep 14, 2017
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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DDx

Diagnostic Considerations

Various disease processes mimic claudication symptoms and must be excluded before a diagnosis of peripheral arterial occlusive disease (PAOD) can be made. Such processes 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 - This is described as a dull, aching pain that typically occurs at the end of the day or after prolonged standing; it is not exacerbated by exercise
  • Neurospinal disease - The 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 rare condition 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; although, as with claudication, the pain occurs with exercise and is relieved with rest, the exercise is at a more strenuous level and the recovery period longer
  • Popliteal entrapment syndrome - This syndrome, similar to intermittent claudication but usually observed in active young people, is caused by various abnormal anatomic configurations of the insertion of the medial gastrocnemius muscle head, which cause 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 - The pain is due to a peripheral neuritis; differentiation from intermittent claudication can be difficult because of accompanying skin discoloration and diminished pulses; extensive neurologic evaluation is essential
  • Venous thrombosis - Swelling and leg pain occur with walking; pain is relieved by extremity elevation, a finding that distinguishes this entity from arterial insufficiency

Differential Diagnoses