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
...reatment...
...ement of Asymptomatic Disease
...commends multidisciplinary comprehensive smokin...
...SVS recommends providing education about the...
...e SVS recommends against invasive treatments for P...
...Medical Treatment for Intermitten...
...SVS recommends multidisciplinary comprehen...
...ecommends statin therapy in patients w...
...e SVS recommends optimizing diabetes control (...
...S recommends the use of indicated...
...nts with IC due to atherosclerosis, the SVS recom...
...mends clopidogrel in doses of 75 mg daily as an...
...IC due to atherosclerosis, the SVS su...
...suggests against using folic acid and v...
...ients with IC who do not have congestive hear...
...atients with IC who cannot tolerate or...
...on for using ramipril in IC was originally made...
...ble 5. Exercise Therap...
...VS recommends as first-line therapy a supervis...
...ecommends home-based exercise, with a goal of â...
...ts who have undergone revascularization therapy f...
...ds that patients with IC be followed up an...
.... General Considerations on Invasive Trea...
...mends endovascular therapy (EVT) or surgical tr...
...ecommends an individualized approach to select a...
...ble 7. Interventions for Aortoiliac Occlusiv...
...e SVS recommends endovascular procedur...
...e SVS recommends endovascular interventions as f...
...he SVS recommends the selective us...
...recommends the use of covered stents for trea...
...ients with diffuse AIOD (eg, extensive...
...8. Interventions for Aortoiliac Occlusiv...
...AIOD in the presence of aneurysmal disease...
...patients undergoing revascularization fo...
...ients with iliac artery disease and i...
...commends direct surgical reconstruct...
...ger patients (age...
...ds either axial imaging (eg, computed tomog...
...ing surgical bypass for aortoiliac...
...any bypass graft originating from the CFA, t...
...vention For Femoropopliteal Occlusive Disease...
...SVS recommends endovascular procedures...
...or focal lesi...
...mediate-length lesions (5–15 cm) in the...
...sts the use of preoperative ultrasou...
...SVS recommends against EVT of isolated i...
...ommends surgical bypass as an initial revascu...
...SVS recommends using the saphenous vein as the pr...
...absence of a suitable vein, the SVS suggests us...
...tinterventional Medical Therapy in Int...
...s after endovascular or open surgica...
...rgoing lower extremity bypass (venous or pro...
...ients undergoing infrainguinal end...
...veillance After Interventions for Intermittent C...
...uggests that patients treated with open o...
...ggests that patients treated with lower ext...
...suggests that patients who have pr...