Claudication with diminished distal pulses

This young female patient presented to the Emergency Department with unstable angina. Her physical exam was remarkable for decreased pulses in the lower extremities and cool distal extremities. She also reported chronic claudication that limited her ability to walk more than 2-3 blocks without having to stop because of thigh pain. During diagnostic cardiac catheterization , arterial access was difficult to obtain from the right femoral artery. The left femoral artery was used successfully to complete the coronary stent procedure. Aortography performed later showed near-occlusion of the distal aorta with abundant collateral flow into the lower extremities. The ankle-brachial index was markedly diminished on both sides. The distal aorta bifurcation was reconstructed by Dr. Carell using the kissing stent technique with balloon expandable stents.