Lower Limb Claudication Due to Iliac Artery Occlusive Disease
A 63-year-oldman presents with a history of worsening pain in his left buttock, thigh and calf on walking. During the preceding 3 months, following the introduction of a beta-blocker for newly diagnosed hypertension, the distance he could walk at a “normal” pace had reduced from 200 to 100 m. The pain ceased almost immediately after stopping walking and appeared again after the same interval. A systemic enquiry revealed recently diagnosed hypertension and life-long history of heavy smoking. He had never experienced cerebro-vascular or cardiac symptoms.
Clinical examination revealed sinus rhythm, full upper limb pulses, a diminished left femoral pulse and absent left popliteal and pedal pulses. The right leg pulses were normal. Both feet appeared well perfused. No bruits were audible in the abdomen or groins. The abdominal aorta was not aneurismal. Ankle pressure brachial indices were 0.74 on the left and 0.93 on the right at rest. On treadmill walking for 100 m the left...
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