Lower Limb Claudication Due to Bilateral Iliac Artery Occlusive Disease: The Case for Iliac Stenting and Femorofemoral Crossover Bypass

  • Jean-Baptiste Ricco
  • Olivier Page
Chapter
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Abstract

A 54-year-old man presents to your clinic complaining of bilateral rest pain of the toes and a past medical history of cramping pain in his calves when he walks. The patient had a 30-pack year smoking history and remains an active smoker. Clinical examination revealed an absent left femoral pulse and a diminished right femoral pulse. Popliteal and pedal pulses were absent on both sides. Bilateral carotid bruits were noted. Palpation of the abdominal aorta was normal. The patient was also moderately breathless on minimal exertion and had a chronic productive cough. The ECG was normal, a chest x-ray showed evidence for chronic obstructive pulmonary disease (COPD). FEV1 was 950 mL not enhanced after inhalation of bronchodilators. The patient was currently taking medications for hypertension and elevated cholesterol.

The patient had a Duplex-scan with measurements of the ABI that was 0.40 on the right side and of 0.29 on the left. The Duplex showed an occlusion of the left external iliac artery and significant stenoses of the right common and external iliac arteries with occlusion of both superficial femoral arteries. The patient had also mild bilateral carotid artery stenosis.

The duplex scan was followed by digital percutaneous subtraction contrast angiography that showed an occlusion of the left external iliac artery and a significant stenosis of the right common and external iliac arteries. Severe occlusive lesions were also seen in both common femoral arteries (Figs. 18.1 – 18.3). The superficial femoral artery was occluded on both sides. Significant lesions of the crural arteries were also present (not shown).

Keywords

Chronic Obstructive Pulmonary Disease Iliac Artery Superficial Femoral Artery Ankle Brachial Index Critical Limb Ischaemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Springer London 2010

Authors and Affiliations

  • Jean-Baptiste Ricco
    • 1
  • Olivier Page
  1. 1.Section of Vascular Surgery and Vascular InterventionUniversity of Poitiers Medical SchoolPoitiersFrance

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