Images in vascular medicine

A 53-year-old man had been treated for the preceding three years for Churg–Strauss syndrome (CSS). The diagnosis was established based on the history of adult-onset bronchial asthma, sinusitis and nasal polyps, eosinophilia in the range of 320–2040/mm, transitory pulmonary inŽ ltrates, mononeuritis multiplex, cardiomyopathy, palpable purpura and miscroscopic hematuria. Skin biopsy showed leukocytoclastic small vessel vasculitis. P-ANCA was positive. The patient was treated with prednisone, azathioprine, digoxin, furosemide and warfarin. Fulminant ischemic symptoms developed in the feet distal to the maleoli. On transfemoral arteriography, the femoral and