Syndrome of internal iliac aery occlusion manifested by

Aerial pulses It is standard practice to examine the femoral, popliteal, posterior tibial and dorsalis pedis aeries together with the abdomen for an aoic aneurysm or renal aery bruit, which may coexist with lower limb occlusive disease. Diminution of a femoral and/or popliteal pulse can often be appreciated by comparing it with its opposite number; however, pedal pulses are either clinically palpable or absent. Popliteal pulses are often difficult to feel; a popliteal aery aneurysm should be suspected if the popliteal pulse is prominent with concomitant loss of the natural concavity of the popliteal fossa. Pulsation distal to an aerial occlusion is usually absent although the presence of a highly developed collateral circulation may allow distal pulses to be palpable - this is most likely to occur with an iliac stenosis. In this case, exercise (walking until claudication develops) usually causes the pulse to disappear as vasodilation occurs below the obstruction, causing the pulse pressure to reduce. An aerial bruit, heard on auscultation over the pulse, indicates turbulent flow and suggests a stenosis. It is an unreliable clinical sign as tight stenoses often do not have bruits. A continuous 'machinery' murmur over an aery usually indicates an aeriovenous fistula. Iliac obstruction Unilateral claudication in the thigh and calf and sometimes the buttock Bruit over the iliac region Unilateral absence of femoral and distal pulses Ref: Bailey and love 27th edition Pgno : 944