Acute Vascular Insufficiency of the Limb

The differential diagnosis of acute vascular insufficiency of the limb in young people includes:

• Premature/accelerated atherosclerosis: Can be due to traditional risk factors for atherosclerosis, drugs (e.g., corticosteroids), and autoimmune and inflammatory mechanisms.
• Buerger disease (thromboangiitis obliterans): Rare disease of small and medium-sized peripheral arteries and veins. Most commonly seen in Ashkenazi Jews in Israel. Smoking is the most important risk factor.
• Adventitial cystic disease: Rare disease of young adults (mainly men) characterized by a highly viscous and mucinous cyst in the adventitia of an artery. The cyst may enlarge, causing compression. Most commonly seen in the popliteal artery.
• Adductor canal compression syndrome: Similar mechanism as popliteal artery entrapment syndrome (see below). Due to compression of the superficial femoral artery by an abnormal musculotendinous band arising from the adductor magnus muscle and lying adjacent and superior to the adductor tendon. Can occur following exercise.
• Popliteal artery entrapment syndrome: Due to anomalous anatomic relationships between the popliteal artery and surrounding musculotendinous structures. Most commonly, the popliteal artery courses through or around the medial head of the proximal gastrocnemius muscle.
• Microemboli.
• Collagen vascular disease.
• Takayasu arteritis: Vasculitis of the large vessels, usually involving the aorta and its main branches, and the upper extremities. Typically affects Asian women younger than 40 years of age.
• Coagulopathy.

References

• Małecki R, Zdrojowy K, Adamiec R. Thromboangiitis obliterans in the 21st century--a new face of disease. Atherosclerosis. 2009 Oct;206(2):328-34. Epub 2009 Feb 12.
• Papas TT, Georgiadis GS, Maltezos CK, Lazarides MK. Adventitial cystic disease of the popliteal artery: a potential cause of intermittent claudication. Wien Klin Wochenschr. 2007;119(5-6):186-8.
• Radonić V, Koplić S, Giunio L, Bozić I, Masković J, Buća A. Popliteal artery entrapment syndrome: diagnosis and management, with report of three cases. Tex Heart Inst J. 2000;27(1):3-13.
• Verta MJ Jr, Vitello J, Fuller J. Adductor canal compression syndrome. Arch Surg. 1984 Mar;119(3):345-6.