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Difficulty: HardCardiothoracic and Vascular Surgery

Match each of the following clinical presentations with the most likely underlying vascular pathology.

  • A 60-year-old man presenting with buttock claudication, erectile dysfunction, and absent bilateral femoral pulses.Aortoiliac occlusive disease
  • A 68-year-old man developing painful, cyanotic toes with intact pedal pulses two days after undergoing coronary angiography.Cholesterol atheroembolism
  • A 45-year-old male heavy smoker presenting with recurrent migratory superficial thrombophlebitis and distal digital ulcerations.Thromboangiitis obliterans
  • A 72-year-old woman with a history of weight loss and 'food fear' who now presents with sudden-onset, severe abdominal pain that is out of proportion to physical exam findings.Acute-on-chronic mesenteric ischemia
  • A 55-year-old woman experiencing episodes of vertigo, diplopia, and syncope primarily when vigorously exercising her left upper extremity.Subclavian steal syndrome

Answer

The correct matches align the man with buttock claudication to Aortoiliac occlusive disease, the post-angiography man to Cholesterol atheroembolism, the young smoker to Thromboangiitis obliterans, the woman with abdominal pain to Acute-on-chronic mesenteric ischemia, and the woman with arm-exercise-induced vertigo to Subclavian steal syndrome.
Each pairing relies on identifying pathognomonic clinical features for major vascular pathologies. Aortoiliac occlusive disease (Leriche syndrome) is recognized by the triad of claudication, impotence, and absent femoral pulses. Cholesterol atheroembolism presents with blue toes but intact pulses after endovascular procedures. Thromboangiitis obliterans targets distal vessels and veins in young smokers. Acute-on-chronic mesenteric ischemia presents with a history of intestinal angina followed by sudden severe abdominal pain out of proportion to exam. Subclavian steal syndrome presents with vertebrobasilar insufficiency triggered by ipsilateral arm exercise.

Step-by-Step Solution

1
Analyze the first clinical presentation detailing buttock claudication, erectile dysfunction, and absent femoral pulses.
This specific symptom triad identifies Leriche syndrome.
Recognizing this classic triad points to severe narrowing of the distal aorta and iliac arteries, known as Aortoiliac occlusive disease.
2
Evaluate the second presentation of cyanotic toes with intact pedal pulses following coronary angiography.
This presentation identifies blue toe syndrome caused by an iatrogenic event.
Endovascular procedures can dislodge aortic atherosclerotic plaques, leading to Cholesterol atheroembolism in small distal vessels.
3
Examine the third case of a young male heavy smoker with migratory superficial thrombophlebitis and distal ulcerations.
This patient demographic and symptom profile is highly specific for Buerger disease.
These findings characterize Thromboangiitis obliterans, an inflammatory vasculopathy strongly associated with tobacco use.
4
Assess the fourth case of chronic 'food fear' transitioning to acute, severe, out-of-proportion abdominal pain.
The chronic symptoms suggest intestinal angina, while the acute severe pain suggests acute bowel ischemia.
This progression matches Acute-on-chronic mesenteric ischemia, often due to thrombosis of a severely atherosclerotic mesenteric artery.
5
Analyze the fifth presentation of vertigo and diplopia triggered by left arm exercise.
These vertebrobasilar symptoms triggered by upper extremity exertion identify a 'steal' phenomenon.
Stenosis of the proximal subclavian artery causes reverse flow in the vertebral artery during arm exercise, known as Subclavian steal syndrome.

Key Concept

Clinical recognition of hallmark vascular surgery syndromes based on patient demographics, specific symptom triggers, and distinct physical exam findings.
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Topics

Cardiothoracic and Vascular Surgery

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