Exertional Leg Pain

This 60 year old woman presented to her primary care physician complaining of intermittent left lower leg burning with activity. Initially her symptoms were mild and did not limit her daily activities. She did well with a walking program. After 1-2 years or stable symptoms, her claudication increased and began affecting her ability to walk at the grocery store. She tried medical therapy with Pletal but her symptoms continued to progress to the point where she became limited after walking 1-2 blocks on flat ground. She had a very abnormal vascular duplex examination and was ultimately referred for diagnostic peripheral angiography and revascularization.

Angiography showed severe bilateral disease affecting the superficial femoral arteries. No signficant disease was seen in the iliac system and runoff into the feet was good. Shown here is the proximal left superficial artery with a tight stenosis. Following balloon PTA with a 6 mm balloon, the artery was widely patent without luminal disruption. The other leg was also treated and the patient has subsequently done well and was convinced to stop smoking.