A patient with suspected arterial occlusive disease presents with absent femoral pulse, dependent rubor, and claudication in buttocks, hamstrings, and calf. Where is the occlusion MOST likely?

• A. Femoral artery
• B. Iliac artery
• C. Popliteal artery
• D. Tibial artery

Answer: (C)

This item tests localization of arterial occlusion from pulse findings and claudication pattern. An absent femoral pulse points to disease proximal to the femoral artery, typically in the iliac arteries or aortoiliac region. Claudication in the buttocks plus the hamstrings and calves strongly suggests involvement of the iliac/aortoiliac system, because the gluteal and proximal thigh regions are supplied by arteries branching from the iliac system. Dependent rubor reinforces the presence of significant arterial insufficiency.

Therefore, the occlusion is most likely in the iliac arteries (aortoiliac region), not in the popliteal or tibial arteries. An occlusion in the popliteal would leave the femoral pulse intact, and tibial-level disease would mainly cause distal (foot) symptoms with a present femoral pulse.