Chronic compartment syndrome. This overuse injury, usually of well-conditioned athletes, is not responsive to anti-inflammatory medication or physical therapy. Rest improves the pain, but it usually returns with resumption of exercise. The diagnosis is made by measuring the compartment pressures (normal pressure is 15 mmHg and in chronic compartment syndrome it is 20 mmHg). Treatment is surgical, either open fasciectomy or subcutaneous fasciotomy.
Which arteries are affected in PVD?
The most commonly affected artery is the superficial femoral artery. The aortoiliac and tibioperoneal arteries are affected less commonly. One-third of patients will have more than one area involved.
Can the history help in localizing the area of disease?
Aortoiliac disease may cause claudication of the buttock or thigh or impotence in men. Disease at this level may cause isolated calf claudication. Femoropopliteal disease also causes calf claudication.
What is the best physical finding for diagnosing PVD?
An abnormal posterior tibial pulse has a sensitivity of 70% and a specificity of 91% in diagnosing PVD.
Will PVD gradually worsen in a patient and cause loss of the leg?
Only 2-4% of all patients with claudication will require amputations. Smoking and diabetes increase the rate of amputations by four and seven times, respectively. Unfortunately, the overall mortality for patients is increased two to three times over that of aged- and sex-matched controls, mainly due to coronary artery and cerebrovascular disease.