Intermittent Claudication in a Young Adult
A 38-year old man is referred to a vascular clinic due to a 3-month history of left calf pain after walking about two blocks. Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) and common analgesics do not relieve his symptoms. He is a nonsmoker and his medical history includes dyslipidemia and a surgery for left anterior cruciate ligament rupture 10 years ago. He has no family history of cardiac disease. Laboratory workup, except for an LDL-C value of 145 mg/dl, is completely normal. Physical examination reveals palpable distal pulses to the left and right lower extremity, however distal pulses to the left foot are decreased with ipsilateral knee flexion. Right and left ankle-brachial index (ABI) values at rest are 1.3 and 1.2 respectively. A magnetic resonance imaging (MRI) is ordered and reveals small round masses in the arterial wall of the popliteal artery.
What is the most likely diagnosis in this patient?