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Difficulty: MediumCardiothoracic and Vascular Surgery

Match each clinical presentation and physical examination finding to the most appropriate surgical vascular pathology.

  • Symmetrical absence of femoral pulses, bilateral buttock claudication, and erectile dysfunctionAortoiliac occlusive disease (Leriche syndrome)
  • Left arm claudication, episodic vertigo with exertion, and a 20 mm Hg systolic blood pressure differential between armsSubclavian steal syndrome
  • Acute onset of agonizing lower extremity pain, pallor, and pulselessness overlying a prominent, pulsatile posterior knee massThrombosed popliteal artery aneurysm
  • Paresthesias in the medial forearm, exertional hand weakness, and obliteration of the radial pulse upon arm abductionThoracic outlet syndrome

Answer

The presentations correspond respectively to Aortoiliac occlusive disease, Subclavian steal syndrome, Thrombosed popliteal artery aneurysm, and Thoracic outlet syndrome.
Each specific vascular pathology has distinct anatomical and hemodynamic consequences. Aortoiliac occlusion restricts flow entirely to the pelvis and legs. Subclavian steal hemodynamically reverses vertebral flow to supply the exercising arm. Popliteal aneurysms are highly prone to sudden thrombosis, causing limb-threatening ischemia. Thoracic outlet syndrome mechanically compresses nerves and vessels only in specific shoulder positions.

Step-by-Step Solution

1
Analyze the triad of bilateral buttock pain, impotence, and diminished femoral pulses.
Identified as Aortoiliac occlusive disease.
These findings precisely localize the arterial block to the aortic bifurcation, compromising flow to both the pelvis and lower extremities.
2
Evaluate arm claudication accompanied by vertigo and a significant blood pressure gradient.
Identified as Subclavian steal syndrome.
The pressure gradient indicates a subclavian stenosis, while the vertigo confirms vertebrobasilar insufficiency due to retrograde vertebral flow.
3
Assess the acute limb ischemia associated with a localized posterior knee pulsatile mass.
Identified as a Thrombosed popliteal artery aneurysm.
Popliteal aneurysms frequently undergo acute thrombosis or shed emboli, rapidly progressing to a pale, pulseless, and painful limb.
4
Examine the arm paresthesias associated with positional loss of the radial pulse.
Identified as Thoracic outlet syndrome.
Mechanical compression of the neurovascular bundle at the thoracic outlet produces lower trunk brachial plexopathy and positional vascular compromise.

Key Concept

Vascular Syndromes and Clinical Presentation
Estimated Time:1m 30s
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Topics

Cardiothoracic and Vascular Surgery

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