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A 46-year-old woman presented with lifestyle-limiting claudication of the legs. Symptoms had progressed over the previous seven years. She had hypertension, hyperlipidemia, and a smoking history of one pack per day for 30 years. Physical examination revealed nonpalpable femoral, popliteal, dorsalis pedis, and posterior tibial pulses bilaterally. There were no skin changes or ulceration of the legs and feet. Noninvasive vascular tests revealed severe aortoiliac occlusive disease, with monophasic Doppler signals from the groin to the feet on both sides. The ankle–brachial indexes were markedly reduced, at 0.32 on the right and 0.30 on the left. A computed tomographic angiogram . . . [Full Text of this Article] |
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