Question

A 30-year-old man presents with cramping gluteal (buttock) pain after walking 500 m. Which vascular segment is involved?

• A. Arterial disease with aortoiliac involvement
• B. Arterial disease with femoral artery involvement
• C. Femoral venous insufficiency
• D. None

Hint:

Claudication is felt one level below the block, so buttock pain points where?

Answer 1

The Correct Option is A

Use the 'one level below' rule of claudication. Exertional cramp that eases on rest is arterial claudication, so first discard the venous option, which produces heaviness and swelling rather than a walking-limited cramp. Now localise: the symptomatic muscle group sits one segment distal to the blocked artery. Calf pain implies femoropopliteal (superficial femoral) disease, the most common site. Thigh or buttock pain implies the inflow above it, the aortoiliac segment. This man's pain is in the buttock after a fixed walking distance, so the lesion is at the aortoiliac level. As a bonus association, aortoiliac occlusion plus impotence in a male defines Leriche syndrome. Therefore the involved vessel territory is aortoiliac arterial disease.