Clinical Presentation

The patient is a 73-year-old veteran with a history of vascular surgery and a cold right foot.

(A) Selected image from a nonselective digital subtraction arteriogram of the abdominal aorta showing patent renal arteries, an accessory left lower renal artery that has an ostial stenosis, and a patent aorto-bifemoral graft with an end-to end anastomosis to the aorta. (B) Patent right and left limbs of the aorto-bifemoral graft. Post-surgical changes are identified in the left limb of the graft at the femoral anastomosis. The takeoff of a left femoral–popliteal graft is identified (arrow