This is a 68 F with hypertension, diabetes, dyslipidemia and peripheral arterial disease who had prior interventions of the right lower extremity. She presented to the office with life style limiting claudication that has progressed to pain at rest despite optimal medical and exercise therapy. Non invasive studies showed severely reduced ABI and complete occlusion of the left popliteal artery and is now referred for peripheral angiography / endovascular intervention.