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

Chronic Exertional Compartment Syndrome
Chronic Venous Insufficiency
Degenerative Disk Disease
Osteoarthritis
Spinal Stenosis
Thromboangiitis Obliterans
Varicose Vein Surgery

Workup

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Media Gallery

Peripheral arterial occlusive disease. Measuring segmental pressures.
Peripheral arterial occlusive disease. Angiogram shows superficial femoral artery occlusion on one side (with reconstitution of suprageniculate popliteal artery) and superficial femoral artery stenosis on other side. This is most common area for peripheral vascular disease.
Peripheral arterial occlusive disease. Procedures performed during acute admission for peripheral arterial disease in US from 1996 to 2005. Reprinted from Journal of Vascular Surgery, Vol 49(4), Rowe VL et al, Patterns of treatment for peripheral arterial disease in the United States: 1996-2005, Pages 910-7, Apr 2009, with permission from Elsevier.

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Peripheral Arterial Occlusive Disease Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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