Atherosclerotic Occlusive Disease of the Lower Extremities
Diagnosis
Diagnosis
Figure 1. Odds Ratios (ORs) for Risk Factors for Peripheral Arterial Disease (PAD)
Figure 2. Natural History of Intermittent Claudation (IC)
Table 1. Diagnosis of Peripheral Arterial Disease (PAD)
Table 2. The Differential Diagnosis for Intermittent Claudication (IC)
| Condition | Location | Prevalence | Characteristic | Effect of exercise | Effect of rest | Effect of position | Other characteristic |
|---|---|---|---|---|---|---|---|
| Calf IC | Calf muscles | 3% of adult | Cramping, aching discomfort | Reproducible onset | Quickly relieved | None | May have atypical limb symptoms on exercise |
| Thigh and Buttock IC | Buttocks, hip, thigh | Rare | Cramping, aching, discomfort | Reproducible onset | Quickly relieved | None | Impotence. May have normal pedal pulses with isolated iliac artery disease |
| Foot IC | Foot arch | Rare | Severe pain on exercise | Reproducible onset | Quickly relieved | None | Also may present as numbness |
| Chronic compartment syndrome | Calf muscles | Rare | Tight, bursting pain | After much exercise (jogging) | Subsides very slowly | Relief with elevation | Typically heavily muscled athletes |
| Venous claudication | Entire leg, worse in calf | Rare | Tight, bursting pain | After walking | Subsides slowly | Relief speeded by elevation | History of iliofemoral deep vein thrombosis, signs of venous congestion, edema |
| Nerve root compression | Radiates down leg | Common | Sharp lancinating pain | Induced by sitting, standing, or walking | Often present at rest | Improved by change in position | History of back problems. Worse with sitting. Relief when supine or sitting. Not intermittent |
| Symptomatic Baker cyst | Behind knee, down calf | Rare | Swelling, tenderness | With exercise | Present at rest | None | Not intermittent |
| Hip arthritis | Lateral hip, thigh | Common | Aching discomfort | After variable degree of exercise | Not quickly relieved | Improved when not weight bearing | Symptoms variable. History of degenerative arthritis |
| Spinal stenosis | Often bilateral buttocks, posterior leg | Common | Pain and weakness | May mimic IC | Variable relief but can take a long time to recover | Relief by lumbar spine flexion | Worse with standing and extending spine |
| Foot/ankle arthritis | Ankle, foot, arch | Common | Aching pain | After variable degree of exercise | Not quickly relieved | May be relieved by not bearing weight | Variable, may relate to activity level and present at rest |
Adapted from Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)
Treatment
...reatmen...
...agement of Asymptomatic Disea...
...ommends multidisciplinary comprehensive smoking...
...ecommends providing education about the signs and...
...ends against invasive treatments f...
...al Treatment for Intermittent Claudicat...
...VS recommends multidisciplinary compreh...
...nds statin therapy in patients with symptomatic PA...
...S recommends optimizing diabetes con...
...ends the use of indicated β-blockers (eg...
...atients with IC due to atherosclerosis, the SVS r...
...ds clopidogrel in doses of 75 mg daily as an effe...
...with IC due to atherosclerosis, the...
...SVS suggests against using folic ac...
...patients with IC who do not have congestive h...
...n patients with IC who cannot tolerat...
...n for using ramipril in IC was ori...
...Exercise Therapy...
...commends as first-line therapy a superv...
...e SVS recommends home-based exercise, with a goa...
...have undergone revascularization therapy fo...
...he SVS recommends that patients with IC...
...al Considerations on Invasive Treatment for...
...recommends endovascular therapy (EVT) o...
...ends an individualized approach to select an invas...
...able 7. Interventions for Aortoili...
...S recommends endovascular procedures over...
...mends endovascular interventions as fir...
...VS recommends the selective use of BMS or covere...
...VS recommends the use of covered stents for...
...r patients with diffuse AIOD (eg, exte...
...erventions for Aortoiliac Occlusive Disease in I...
...D in the presence of aneurysmal disease shou...
...ents undergoing revascularization for...
...tients with iliac artery disease and involvement...
...ommends direct surgical reconstruc...
...n younger patients...
...he SVS recommends either axial imaging (eg, c...
...forming surgical bypass for aortoiliac disease, c...
...raft originating from the CFA, the donor...
...vention For Femoropopliteal Occlusive Dis...
...SVS recommends endovascular procedures over o...
...focal lesions (...
...ermediate-length lesions (5–15 cm)...
...he SVS suggests the use of preoperati...
...S recommends against EVT of isolat...
...nds surgical bypass as an initial revascular...
...commends using the saphenous vein as...
...absence of a suitable vein, the SVS suggests...
...tinterventional Medical Therapy in Intermit...
...patients after endovascular or open...
In patients undergoing lower extremity byp...
...ergoing infrainguinal endovascular inter...
...ble 11. Surveillance After Interventi...
...he SVS suggests that patients trea...
...S suggests that patients treated with low...
...he SVS suggests that patients who have pre...