Which condition presents with intermittent claudication and an ankle-brachial index less than 0.9, with arteriography as the gold standard for diagnosis?

• A. Phlebitis/Thrombophlebitis
• B. Varicose Veins
• C. Peripheral Artery Disease
• D. Aortic Aneurysm

Answer: (C)

Intermittent claudication with an ankle-brachial index below 0.9 points to peripheral artery disease, a disease of the arteries usually from atherosclerosis that reduces blood flow to the legs during activity. The ABI is a simple, noninvasive test that compares the systolic blood pressure at the ankle with that at the arm; a value under 0.9 indicates arterial insufficiency in the legs.

Arteriography is considered the gold standard for diagnosing PAD because it provides a detailed map of where blockages are and how severe they are, which is essential for planning possible interventions such as angioplasty or bypass.

Other conditions don’t fit this presentation. Phlebitis or thrombophlebitis involves inflammation of a vein with signs like redness, warmth, and swelling rather than reduced arterial blood flow. Varicose veins are a venous issue presenting with visibly enlarged veins and edema, not an ABI-compatible arterial insufficiency. An aortic aneurysm involves dilation of the aorta and often presents with a pulsatile abdominal mass or different pain patterns rather than claudication with a low ABI.