• Images in cardiology

A 76 year old man, who had neither claudication nor lower extremity rest pain, consulted our hospital because he was suspected of having arteriosclerosis obliterans of both inferior limbs. He had suffered from severe hypertension for 26 years and developed myocardial infarction at 61 years of age.

Magnetic resonance angiography revealed the complete occlusion of the abdominal aorta associated with a solitary kidney, and extensive collateral vascular supply to the lower extremities. Digital subtraction angiography confirmed the complete occlusion of the abdominal aorta and a solitary kidney with a high grade ostial atherosclerotic right renal artery stenosis. Three dimensional computer tomography revealed that the extensive collateral vascular supply to the lower extremities originated from the internal thoracic artery–superior epigastric artery, and the superior mesenteric artery to the external iliac artery (right). From these observations, the patient was diagnosed as having perirenal abdominal aortic occlusion with a solitary kidney. We suggested that he did not have any symptoms such as claudication or lower extremity rest pain because of extensive collateral vascular supply to the lower extremities.