A 55-year-old male smoker presents with claudication of the buttocks and thighs, erectile dysfunction, and absent femoral pulses bilaterally. Ankle-brachial index is 0.4. At which anatomical level is the atherosclerotic obstruction located?
- A Terminal aorta and common iliac arteries ✓
- B Superficial femoral artery in Hunter canal
- C Popliteal and tibial arteries
- D Renal artery ostia with secondary renal ischemia
Correct answer: A. Terminal aorta and common iliac arteries
Explanation
The triad of buttock and thigh claudication, erectile dysfunction, and absent femoral pulses constitutes Leriche syndrome, caused by atherosclerotic occlusion at the terminal aorta and common iliac arteries. Obstruction below the inguinal ligament, such as superficial femoral artery disease, preserves the femoral pulse. Renal artery stenosis causes renovascular hypertension rather than this triad. Recognizing the level of obstruction from the pulse examination is a standard clinical-pathological correlation tested in these exams.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.