Clinical Presentation

A 60-year-old woman presents with buttock claudication. Pulses in the common femoral artery are not palpable.

(A) Aortogram from the brachial approach shows complete aortic occlusion below the superior mesenteric artery (SMA). The SMA supplies the middle colic artery (large arrowhead), marginal artery (small arrow), ascending branch of the left colic artery (large arrow), and superior rectal artery (small arrowhead). (B) Delayed view: the ascending branch of the left colic artery supplies the inferior mesenteric artery (IMA: arrowhead) and then the superior rectal artery (arrow). (C) Further delayed view: branches of the internal iliac ar ter y (pudendal, obturator) reconstitute the internal iliac (arrow), external iliac (arrowhead), and common femoral arteries to supply the legs.

Differential Diagnosis