title: Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease.
abstract: OBJECTIVE
  To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD).
  
  
  METHODS
  Cross sectional, observational study conducted at 96 internal medicine services.
  
  
  METHODS
  1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9.
  
  
  RESULTS
  Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%.
  
  
  CONCLUSIONS
  Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.
authors.affiliation: Heart Failure and Vascular Risk Unit, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. luis.manzano@uah.es
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.forename: Juan de D
authors.initials: Jde D
authors.lastname: García-Díaz
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez
authors.forename: José Ma
authors.initials: JM
authors.lastname: Mostaza
authors.forename: Marc
authors.initials: M
authors.lastname: Cairols
authors.forename: Enrique
authors.initials: E
authors.lastname: González-Sarmiento
authors.forename: Alipio Mangas
authors.initials: AM
authors.lastname: Rojas
authors.forename: Paula
authors.initials: P
authors.lastname: Vieitez
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Sánchez-Zamorano
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
mesh_terms: D000368:Aged; D000465:Algorithms; D002081:Buttocks; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013848:Thigh