Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
J Vasc Surg. 2021 Jun;73(6):2114-2121. doi: 10.1016/j.jvs.2020.11.027. Epub 2020 Dec 2.
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.
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.
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 P < .01) than patients with PAD (n = 41, 39% female, 72 years; range, 51-93 years). Having CECS was associated with a significantly higher combined symptom score at rest (P = .02). During exercise, patients with CECS experienced more tightness, muscle weakness and altered sensation (P < .01), but not pain and cramps (P = .36; P = .70). Exercise-induced complaints occurred much later in patients with CECS than in patients with PAD (15 minutes vs 4 minutes; P < .01). Persistence of pain over 4.5 minutes proved most discriminative for the presence of CECS (sensitivity, 95%; specificity, 54%; positive predictive value, 65%). Exercise cessation completely alleviated complaints in all patients with PAD (n = 41) but not in 73% (n = 29) of the patients with CECS. Ongoing discomfort strongly predicted the presence of CECS (sensitivity, 73%; specificity, 100%; positive predictive value, 100%).
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.
外周动脉疾病（PAD）和慢性运动性肌肉骨骼损伤（CECS）都会导致运动诱发的下肢疼痛。CECS 主要发生在年轻人中，因此在间歇性跛行的老年患者中可能不会被考虑。我们的研究目的是确定 CECS 患者与 PAD 患者之间在特征和症状方面的差异，这些差异可能有助于识别 50 岁以上运动诱发下肢疼痛的 CECS 患者。
在这项病例对照研究中，我们从一个前瞻性随访队列中选择了 50 岁以上的 CECS 患者，并将其与一组新诊断的 50 岁以上的 PAD 患者进行了比较。问卷调查评估了下肢疼痛、紧绷、痉挛、肌肉无力以及休息和运动时皮肤感觉改变的频率和严重程度。
在休息时，CECS 患者（n=43，女性占 42%，57 岁；年龄范围 50-76 岁）报告的疼痛、紧绷、肌肉无力和皮肤感觉改变明显多于 PAD 患者（n=41，女性占 39%，72 岁；年龄范围 51-93 岁）（所有 P<0.01）。患有 CECS 与休息时的综合症状评分显著升高有关（P=0.02）。在运动时，CECS 患者的紧绷、肌肉无力和感觉改变更明显（P<0.01），但疼痛和痉挛不明显（P=0.36；P=0.70）。CECS 患者的运动诱发症状出现得比 PAD 患者晚得多（15 分钟 vs 4 分钟；P<0.01）。疼痛持续 4.5 分钟以上对 CECS 的存在最具鉴别力（敏感性 95%，特异性 54%，阳性预测值 65%）。运动停止完全缓解了所有 PAD 患者（n=41）的症状，但只有 73%（n=29）的 CECS 患者的症状缓解。持续不适强烈提示 CECS 的存在（敏感性 73%，特异性 100%，阳性预测值 100%）。
50 岁以上的 CECS 患者报告的症状模式与 PAD 患者不同。这些差异可能有助于血管外科医生识别患有 CECS 的老年患者。
