Document Detail

Systematic diagnostic approach to proximal-without-distal claudication in a vascular population.
MedLine Citation:
PMID:  16314239     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: Very few observations of proximal-without-distal claudication have been reported in the literature. This is likely due to the use of questionnaires limiting vascular claudication to the calves and to the problems encountered in attributing unexplained "buttock" claudication to a vascular origin. METHODS: During a 2 1/2-year period, we searched for proximal-without-distal exercise-related pain with the San Diego claudication questionnaire among some 2000 patients referred for lower limb arterial investigations. Of these patients, 97 presented no contraindication to treadmill testing and were investigated with exercise transcutaneous oxygen pressure (tcpO2). We used buttock tcpO2 (DROP index<-15 mm hg) to argue for the presence of ischemia on the corresponding side. RESULTS: Ischemia consistent with symptoms was found in 61 patients, whereas pain on one or both sides without underlying ischemia was found in 36 patients, suggesting a non-arterial origin of the symptoms. More than half of the patients with proximal-without-distal claudication and underlying exercise-related ischemia had been suffering for more than 2 years before they were referred to the laboratory. Eleven of the patients were treated. The treatment was successful in all but one of them. CONCLUSIONS: An important delay before diagnosis is frequently observed in proximal-without-distal claudication. TcpO2 is useful in attributing proximal exercise-related pain to a vascular origin. Given the number of detected and successfully treated patients in this small monocentric study, it is surprising that so few observations have been published to date, suggesting that proximal-without-distal arterial claudication is most likely an underestimated diagnosis.
J Picquet; V Jaquinandi; J L Saumet; G Leftheriotis; B Enon; P Abraham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of internal medicine     Volume:  16     ISSN:  0953-6205     ISO Abbreviation:  Eur. J. Intern. Med.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-29     Completed Date:  2006-02-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9003220     Medline TA:  Eur J Intern Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  575-9     Citation Subset:  -    
Department of Vascular Surgery, University Hospital, Angers, France.
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