Lower Limb Pain During Physical Activity

Pain is relieved after short rest.

Figure 1. CT angiography MPI image showing long segment of complete occlusion of the left superficial femoral artery (its length about 13.5 mm, black arrows) with prominent profunda femoris artery (open arrows).

Figure 2. CT angiography MPI image showing long segment of complete occlusion of the left superficial femoral artery (its length about 13.5 mm, black arrows) with prominent profunda femoris artery (open arrows).

Figure 3A. CTA 3D volume rendering showing occluded left femoral artery (white arrows), bilateral anterior tibial arteries occlusion after short segment of their origin (yellow arrows), and left peroneal artery occlusion (grey arrow). Attenuated caliber of the RT posterior tibial artery (arrow head).

Figure 3B. CTA 3D volume rendering showing occluded left femoral artery (white arrows), bilateral anterior tibial arteries occlusion after short segment of their origin (yellow arrows), and left peroneal artery occlusion (grey arrow). Attenuated caliber of the RT posterior tibial artery (arrow head).

Figure 4. CTA 3D volume rendering showing occluded left femoral artery (white arrows), bilateral anterior tibial arteries occlusion after short segment of their origin (yellow arrows), and left peroneal artery occlusion (grey arrow). Attenuated caliber of the RT posterior tibial artery (arrow head).

Figure 5. Axial CTA image showing nonopacified left superficial femoral artery compared to the normally enhanced other side (vertical black arrow). Calcified atheromatous plaques along the vessels.

Diagnosis: Peripheral arterial occlusive disease (ischemia)

Doppler ultrasonography is a noninvasive technique and most widely used as the first step in any patient with claudication pain.

CT angiography is another noninvasive technique which utilizes contrast medium injection to opacify the arterial lumen and detect any change in the caliber.

MR angiography is a noninvasive technique which can be acquired without contrast administration, however, sometimes it overestimates stenosis.

Type D lesions have chronic total occlusion of the common or superficial femoral artery.

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis.