Question

A male patient presents with impotence and bilateral resting pain. The following finding is seen in the legs. At which level has the pathology occurred?

• A. Bilateral popliteal arteries
• B. Bilateral internal iliac arteries
• C. Aortoiliac bifurcation
• D. Bilateral femoral arteries

Answer 1

The Correct Option is C

To determine the level of pathology in this case, we need to recognize the symptoms and correlate them with the vascular supply of the legs. The patient presents with impotence and bilateral resting pain, which suggests a significant obstructive vascular issue affecting distal blood flow. The association of impotence (erectile dysfunction) and leg pain is known as Leriche syndrome, often due to aortoiliac occlusive disease. The aorta bifurcates into the common iliac arteries, which then branch into the internal iliac arteries (supplying pelvic organs, including those involved in erectile function) and external iliac arteries (supplying the lower limbs). An obstruction at the aortoiliac bifurcation thus affects blood flow to both the pelvis and the lower limbs, causing impotence and bilateral leg pain.

Level of Pathology	Symptoms
Aortoiliac bifurcation	Impotence and bilateral resting pain

The correct diagnosis is an obstruction at the aortoiliac bifurcation, consistent with the symptoms of both pelvic and limb ischemia.