A 68-year-old man presented to the emergency department with the complaint of a sudden onset of atraumatic right lower extremity pain. The pain had started shortly after using crack cocaine. He reported sharp and burning pain throughout his leg. He denied chest pain, shortness of breath, abdominal pain, and focal neurologic symptoms. His medical history was otherwise unremarkable. Examination The patient was alert and oriented but in obvious distress.
Vital signs were normal, except blood pressure which was 180/100 mmHg. Cardiopulmonary and abdominal examinations were benign with a notably equal radial pulse. The right lower extremity was cold to touch without palpable pulses distal to and including the common femoral artery. The left lower extremity was warm with bounding pulses. Neurologic examination was normal. Symmetric strength was observed in his bilateral upper and lower…
