Acute presentation of atherosclerotic total distal abdominal aorta occlusion

We are presenting the case of a 49-year-old man, a heavy smoker, who had weakness and wasting of the lower limbs along with neuropathic pain for several months for which no medical care was sought. Presentation to the emergency was prompted by a sudden development of pain in the buttocks and cyanosis of the lower limbs. Investigations revealed total atherosclerotic occlusion of the infrarenal abdominal aorta with collateral circulation that was responsible for the delayed presentation. Anticoagulation with heparin was initiated but the patient refused to undergo any invasive procedure. This case highlights that atherosclerotic disease of the aortoiliac region or distal abdominal aorta can present with long-standing symptoms apparently of a neurologic disorder with muscle weakness and wasting rather than an occlusive vascular disease. The symptoms of lower limb claudication and pain may be ignored until a catastrophic complete occlusion supervenes manifesting as acute ischemia as in our case.