Match each clinical presentation of a vascular disorder with its most likely underlying anatomic pathology or mechanism.
- A 45-year-old man with exertional fatigue of the left arm, episodic dizziness during upper extremity exercise, and a 25 mm Hg difference in resting systolic blood pressure between the arms.Proximal left subclavian artery stenosis resulting in retrograde vertebral blood flow
- A 55-year-old man with cramping pain in the buttocks and thighs after walking one block, absent femoral pulses bilaterally, and new-onset erectile dysfunction.Chronic complete occlusion of the distal abdominal aorta and bilateral common iliac arteries
- A 68-year-old woman with chronic aching pain in the right calf upon exertion, diminished right dorsalis pedis pulse, and loss of hair over the distal right lower extremity.Atherosclerotic narrowing of the superficial femoral artery in the adductor canal
- A 30-year-old male athlete with right arm heaviness, tingling in the medial hand, and a diminished radial pulse when the arm is abducted and externally rotated.Compression of the lower trunk of the brachial plexus and subclavian vessels by the anterior scalene muscle
Answer
Subclavian steal syndrome matches proximal subclavian artery stenosis; Leriche syndrome matches aortoiliac occlusion; isolated calf claudication matches superficial femoral artery narrowing; and Thoracic outlet syndrome matches neurovascular compression by the scalene muscle.
Each clinical vignette presents a classic vascular syndrome that localizes to a highly specific anatomic site. Identifying the unique combination of symptoms allows for precise anatomic localization of the vascular pathology, which is the foundational step in surgical evaluation.
Step-by-Step Solution
Key Concept
Clinical correlation of vascular surgery syndromes with their specific anatomic sites of stenosis or compression.