Buttock Claudication due to Aortoiliac Occlusive Disease Misdiagnosed and Treated as Lumbar Spinal Stenosis: A Case Report

Abstract Distinguishing between neurogenic and vascular claudication can be challenging in older patients with degenerative spinal changes and cardiovascular risk factors. We report the case of a 71-year-old male with a 4-year history of exertional left buttock pain without initial presentation of diminished peripheral pulses, skin discoloration, temperature variations, poor hair growth, or trophic skin changes presumed to be neurogenic based on magnetic resonance imaging of L2–L3 lumbar spinal stenosis. He underwent two diagnostic transforaminal epidural steroid injections, followed by endoscopic interlaminar decompression without improvement. Subsequent evaluation revealed a reduced left ankle-brachial index (ABI; 0.71), and computed tomography angiography revealed total occlusion of the left common iliac artery with segmental involvement of other pelvic arteries. The patient underwent successful percutaneous transluminal angioplasty with stenting, which resolved symptoms. Proximal iliac disease could be easily missed in clinical settings with normal distal pulses due to collateral circulation. ABI testing and vascular imaging should be integrated into the diagnostic pathway.