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Differential Diagnosis for Lower Extremity Ischemia and Ulcerations: Focus on Non-atherosclerotic Etiologies

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Critical Limb Ischemia

Abstract

While it is crucial to recognize that atherosclerosis is the most common etiology for lower extremity ischemia, it is important to know the non-atherosclerotic causes of limb ischemia. Since these pathologies are not as prevalent as atherosclerosis, knowledge about these entities helps make a broad differential diagnosis at the initial clinical evaluation. This chapter includes the following non-atherosclerotic cause of limb ischemia: vasculitis, Takayasu’s arteritis, femoral and popliteal artery aneurysms, external iliac artery endofibrosis, cystic adventitial disease, popliteal artery entrapment, persistent sciatic artery, mid-aortic syndrome, thromboangiitis obliterans (Buerger’s disease), Raynaud’s syndrome, calciphylaxis, warfarin-induced skin necrosis, heparin-induced skin necrosis, atheroembolic episodes, radiation, brown recluse spider bite, Ehlers-Danlos syndrome, pseudoxanthoma elasticum, ergot derivatives, and neurogenic claudication.

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References

  1. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5–67.

    Google Scholar 

  2. Lightfoot Jr RW, Michel BA, Bloch DA, et al. The American College of rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum. 1990;33:1088–93.

    Article  PubMed  Google Scholar 

  3. Trickett JP, Scott RA, Tilney HS. Screening and management of asymptomatic popliteal aneurysms. J Med Screen. 2002;9:92–3.

    Article  CAS  PubMed  Google Scholar 

  4. Lawrence PF, Lorenzo-Rivero S, Lyon JL. The incidence of iliac, femoral, and popliteal artery aneurysms in hospitalized patients. J Vasc Surg. 1995;22:409–15. discussion 15-6.

    Article  CAS  PubMed  Google Scholar 

  5. Huang Y, Gloviczki P, Noel AA, et al. Early complications and long-term outcome after open surgical treatment of popliteal artery aneurysms: is exclusion with saphenous vein bypass still the gold standard? J Vasc Surg. 2007;45:706–13. discussion 13-5.

    Article  PubMed  Google Scholar 

  6. Alimi YS, Accrocca F, Barthelemy P, Hartung O, Dubuc M, Boufi M. Comparison between duplex scanning and angiographic findings in the evaluation of functional iliac obstruction in top endurance athletes. Eur J Vasc Endovasc Surg. 2004;28:513–9.

    Article  CAS  PubMed  Google Scholar 

  7. Ford SJ, Rehman A, Bradbury AW. External iliac endofibrosis in endurance athletes: a novel case in an endurance runner and a review of the literature. Eur J Vasc Endovasc Surg. 2003;26:629–34.

    Article  CAS  PubMed  Google Scholar 

  8. Tsilimparis N, Hanack U, Yousefi S, Alevizakos P, Ruckert RI. Cystic adventitial disease of the popliteal artery: an argument for the developmental theory. J Vasc Surg. 2007;45:1249–52.

    Article  PubMed  Google Scholar 

  9. Baxter AR, Garg K, Lamparello PJ, Mussa FF, Cayne NS, Berland T. Cystic adventitial disease of the popliteal artery: is there a consensus in management? Vascular. 2011;19:163–6.

    Article  PubMed  Google Scholar 

  10. Gibson MH, Mills JG, Johnson GE, Downs AR. Popliteal entrapment syndrome. Ann Surg. 1977;185:341–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sinha S, Houghton J, Holt PJ, Thompson MM, Loftus IM, Hinchliffe RJ. Popliteal entrapment syndrome. J Vasc Surg. 2012;55:252–62. e30.

    Article  PubMed  Google Scholar 

  12. Mayschak DT, Flye MW. Treatment of the persistent sciatic artery. Ann Surg. 1984;199:69–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. McLellan GL, Morettin LB. Persistent sciatic artery: clinical, surgical, and angiographic aspects. Arch Surg. 1982;117:817–22.

    Article  CAS  PubMed  Google Scholar 

  14. Brantley SK, Rigdon EE, Raju S. Persistent sciatic artery: embryology, pathology, and treatment. J Vasc Surg. 1993;18:242–8.

    Article  CAS  PubMed  Google Scholar 

  15. Olin JW. Management of patients with intermittent claudication. Int J Clin Pract. 2002;56:687–93.

    CAS  PubMed  Google Scholar 

  16. Kawata E, Kuroda J, Wada K, et al. Hypereosinophilic syndrome accompanied by Buerger’s disease-like femoral arterial occlusions. Intern Med. 2007;46:1919–22.

    Article  PubMed  Google Scholar 

  17. Agarwal P, Agrawal PK, Sharma D, Baghel KD. Intravenous infusion for the treatment of diabetic and ischaemic non-healing pedal ulcers. J Eur Acad Dermatol Venereol. 2005;19:158–62.

    Article  CAS  PubMed  Google Scholar 

  18. Gur'eva MS, Baranov AA, Bagrakova SV, Kurdiukov AA. Pulse-therapy with glucocorticoids and cyclophosphamide in the treatment of thromboangiitis obliterans. Klin Med. 2003;81:53–7.

    Google Scholar 

  19. Fiessinger JN. Juvenile arteritis revisited. Buerger’s disease-Takayasu’s disease. Pathophysiol Haemost Thromb. 2002;32:295–8.

    Article  PubMed  Google Scholar 

  20. Saha K, Chabra N, Gulati SM. Treatment of patients with thromboangiitis obliterans with cyclophosphamide. Angiology. 2001;52:399–407.

    Article  CAS  PubMed  Google Scholar 

  21. Giacomelli R, Pizzuto F, Cucinelli F, Tonietti G. Immunosuppressive therapy of vasculitis: current aspects and perspectives. Recenti Prog Med. 1996;87:124–34.

    CAS  PubMed  Google Scholar 

  22. Fauci AS, Haynes B, Katz P. The spectrum of vasculitis: clinical, pathologic, immunologic and therapeutic considerations. Ann Intern Med. 1978;89:660–76.

    Article  CAS  PubMed  Google Scholar 

  23. Olin JW, Shih A. Thromboangiitis obliterans (Buerger’s disease). Curr Opin Rheumatol. 2006;18:18–24.

    Article  PubMed  Google Scholar 

  24. Olin JW. Thromboangiitis obliterans (Buerger’s disease). N Engl J Med. 2000;343:864–9.

    Article  CAS  PubMed  Google Scholar 

  25. Silman A, Holligan S, Brennan P, Maddison P. Prevalence of symptoms of Raynaud’s phenomenon in general practice. BMJ. 1990;301:590–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Clark, S.E., Aziz, F. (2017). Differential Diagnosis for Lower Extremity Ischemia and Ulcerations: Focus on Non-atherosclerotic Etiologies. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_11

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  • DOI: https://doi.org/10.1007/978-3-319-31991-9_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31989-6

  • Online ISBN: 978-3-319-31991-9

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