Recurrent Peripheral Artery Disease in a 45-Year-Old Male Without Hypercoagulable Comorbidities

Peripheral artery disease (PAD) is a progressive vascular disease characterized by atherosclerotic narrowing of peripheral arteries, resulting in decreased blood flow to the extremities. Common risk factors for PAD are diabetes, hypertension, and hyperlipidemia, although it can also occur in patients without these comorbidities, such as in the use of marijuana or alcohol. Recent research suggests that marijuana and alcohol use lead to endothelial dysfunction and vascular inflammation, conditions found in PAD. We present the case of a 45-year-old male who presented with complaints of left lower leg pain for three months. His past medical history includes PAD involving a left femoral to popliteal arterial bypass surgery in 2017 and a saphenous vein graft revision in 2018. The patient's social history was positive for polysubstance abuse with daily marijuana and alcohol use for the past 20 years. While in the emergency department (ED), a left lower extremity arterial Doppler duplex ultrasound procedure was performed and demonstrated severe atherosclerotic disease with occlusion of the mid and distal superficial femoral artery, popliteal artery, and dorsalis pedis artery. Three days after admission to the ED and following cardiology clearance, the patient underwent a left femoral-tibial arterial bypass with autogenous reverse saphenous graft due to a left femoral and popliteal artery occlusion. This case addresses a potential association between chronic substance use and PAD with a lack of classical risk factors. Although the vascular effects of alcohol and marijuana have been acknowledged in the literature, they remain unrecognized by many physicians. This case highlights the need for increased awareness of potential non-traditional risk factors for PAD, in recognition of earlier intervention and improved patient outcomes.