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