Acute total occlusion of the infrarenal abdominal aorta with distal reconstitution of bilateral lower limbs arteries from epigastric arteries (faint opacification at arteries distal to left mid superficial femoral arteries). This can be caused by thrombus or embolus lodged at the infrarenal abdominal aorta. The differentiation from imaging point of view is difficult. No obvious major organ ischemia.

The blood investigation showed marked increase of creatine kinase (CK), which may support the occlusion of artery is acute event.

Bilateral distal femur and left proximal tibial osteonecrosis/bone infarcts.

Knowing the basic artery anatomy is crucial to determine the possible collateral supply.