55-Year-Old Woman With Leg Pain With Walking

A 55-year-old woman presented to vascular medicine clinic for evaluation of bilateral lower extremity pain that developed over the prior six weeks. She had a longstanding history of hyperlipidemia and tobacco abuse (14 pack-year history of smoking). The patient described fatigue and pain in the hips and thighs when walking. She noted symptoms after walking approximately 15 feet and recently applied for a handicapped parking pass because she was unable to walk from her parking garage to her office at work. She had no lower extremity ulcers or color changes in her feet. She was referred for evaluation by a neurologist; it was felt that her symptoms were not consistent with neurogenic claudication.

Given her symptoms, the patient was referred to the vascular laboratory. Physiologic testing including ankle-brachial indices (ABIs), segmental limb pressures and pulse volume recordings (PVRs) was performed (Figure 1).

Figure 1

Figure 1

Based on the vascular study above, what is the severity of peripheral artery disease (PAD) and what is the level of disease?

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