Presentation
Referred by a hematologist for bilateral leg artery ultrasound to investigate compromised blood supply. The patient stated he had claudication after 10 minutes of walking. The patient was an ex-smoker and had hypertension, which was medically controlled. He had smoked for more than 40 years. Specialist determined ankle-brachial index and aorto-iliac ultrasound assessment were also performed.
Patient Data
A resting ABI study was performed indicating significant disease on the right and less severe disease on the left. Right ABI = 0.69, left ABI = 0.86. Ultrasound examination of both legs revealed mild-to-moderate tibial artery disease bilaterally. However, all arteries examined in both legs were patent and free of haemodynamically significant disease.
Peak systolic velocities in the very distal segment of the aorta indicated a low-grade >75% stenosis.
Elevated velocities indicating a low-grade >75% stenosis were observed in the proximal right common iliac artery. Post-stenotic turbulence was seen in the mid-RCIA.
Elevated velocities indicating a low-grade >75% stenosis were observed in the proximal left common iliac artery. Post-stenotic turbulence was seen in the mid-LCIA.
Case Discussion
Low-grade >75% stenoses at the aortic bifurcation with velocities indicating slightly more advanced disease on the right. This finding, in conjunction with mild-to-moderate tibial artery disease, this may explain the patient's abnormal ABI results and clinical symptoms.
Predominant disease at the aorto-iliac level is seen in 25% of patients. Given the subsequent findings, an exercise ABI or toe photoplethysmography study would likely have revealed that the disease on the left was more severe than indicated by the resting study.
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