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

Step 1: Cramping pain in a muscle group brought on by walking and relieved by rest is intermittent claudication, a hallmark of peripheral arterial disease.
Step 2: The muscle group that claudicates is classically one anatomical level below the diseased artery. Buttock and thigh claudication therefore points to disease at the aortoiliac level.
Step 3: Calf claudication, by contrast, reflects superficial femoral artery disease (the commonest site). Since this patient's pain is in the buttock, aortoiliac arterial disease is the answer.
Clinical pearl: Buttock claudication with erectile dysfunction from aortoiliac occlusion is Leriche syndrome.
Why not the others: Femoral artery disease would give calf, not buttock, pain; venous insufficiency causes aching/heaviness and swelling, not exertional cramp relieved by rest.
Ref: Bailey and Love, Short Practice of Surgery, 27th edition, Pg 943.