TY - JOUR
T1 - Chronic exertional compartment syndrome in the differential diagnosis of peripheral artery disease in older patients with exercise-induced lower limb pain
AU - de Bruijn, Johan A.
AU - Wijns, Kim C. A.
AU - van Kuijk, Sander M. J.
AU - Hoogeveen, Adwin R.
AU - Teijink, Joep A. W.
AU - Scheltinga, Marc R. M.
N1 - Funding Information:
Patients with IC complaints potentially having PAD underwent physical examination aimed at finding primary signs (decreased femoral artery, popliteal artery, posterior tibial artery, and/or dorsal pedal artery pulsations) or secondary signs of arterial insufficiency (skin and nail abnormalities). The attending surgeon also actively screened for potential comorbidities, such as orthopedic disorders, neurologic disorders, CECS, or MTSS during the physical examination. When the history and physical examination were consistent with a diagnosis of PAD, an ABI was performed during a standardized treadmill test. A rest ABI of <0.90 or a decrease of more than 15 mm Hg after walking were required for the diagnosis PAD. If the ABI was inconclusive, ultrasound examination, magnetic resonance angiography (MRA), or computed tomography angiography were performed to detect peripheral arterial stenoses. Patients were diagnosed with PAD when the history and physical examination were consistent with arterial insufficiency and ABI (or ultrasound examination, MRA, or computed tomography angiography) confirmed the diagnosis. None of the patients with PAD was suspected for CECS based on a suggestive history and physical examination. ICP measurements were, therefore, not performed to rule out CECS in these patients with PAD because they are invasive and only support a mostly clinical diagnosis.
Publisher Copyright:
© 2020 Society for Vascular Surgery
PY - 2021/6
Y1 - 2021/6
N2 - Objective: Peripheral artery disease (PAD) and chronic exertional compartment syndrome (CECS) both cause exercise-induced lower limb pain. CECS is mostly described in young individuals and may therefore not be considered in older patients with intermittent claudication. The aim of our study was to identify differences in characteristics and symptomatology between patients with CECS and PAD that may help in recognizing CECS in patients >= 50 years with exercise-induced lower limb pain.Methods: In this case-control study, patients with CECS >= 50 years were selected from a prospectively followed cohort and compared with a sample of newly diagnosed patients with PAD >= 50 years. A questionnaire assessed frequency and severity of lower limb pain, tightness, cramps, muscle weakness, and altered skin sensation at rest and during exercise.Results: At rest, patients with CECS (n = 43, 42% female, 57 years; range, 50-76 years) reported significantly more pain, tightness, muscle weakness and altered skin sensation (all PConclusions: Patients with CECS >= 50 years report a symptom pattern that is different from patients with PAD. These differences may aid vascular surgeons in identifying older patients with CECS.
AB - Objective: Peripheral artery disease (PAD) and chronic exertional compartment syndrome (CECS) both cause exercise-induced lower limb pain. CECS is mostly described in young individuals and may therefore not be considered in older patients with intermittent claudication. The aim of our study was to identify differences in characteristics and symptomatology between patients with CECS and PAD that may help in recognizing CECS in patients >= 50 years with exercise-induced lower limb pain.Methods: In this case-control study, patients with CECS >= 50 years were selected from a prospectively followed cohort and compared with a sample of newly diagnosed patients with PAD >= 50 years. A questionnaire assessed frequency and severity of lower limb pain, tightness, cramps, muscle weakness, and altered skin sensation at rest and during exercise.Results: At rest, patients with CECS (n = 43, 42% female, 57 years; range, 50-76 years) reported significantly more pain, tightness, muscle weakness and altered skin sensation (all PConclusions: Patients with CECS >= 50 years report a symptom pattern that is different from patients with PAD. These differences may aid vascular surgeons in identifying older patients with CECS.
KW - Intermittent claudication
KW - Peripheral artery disease
KW - Chronic exertional compartment syndrome
KW - Older patients
KW - RISK-FACTORS
U2 - 10.1016/j.jvs.2020.11.027
DO - 10.1016/j.jvs.2020.11.027
M3 - Article
C2 - 33278541
SN - 0741-5214
VL - 73
SP - 2114
EP - 2121
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 6
ER -