Abstract
A case of a 63-year-old woman with hypertension, chronic kidney disease, and osteoporosis who presented with acute coronary syndrome and new-onset heart failure. Angiography revealed a completely obstructed abdominal aorta, with no circulation to the femoral arteries and perfusion only through collateral vessels. This severe peripheral arterial disease (PAD) was diagnosed during her hospitalization, raising the question of why it had remained undiagnosed for years and whether earlier detection could have improved her outcome. Women with PAD often present with atypical or absent symptoms, leading to underdiagnosis. Early screening with the Ankle-Brachial Index (ABI) is crucial for accurate diagnosis. Moreover, gaps in PAD recognition led to inadequate treatment of comorbidities, less aggressive pharmacologic therapies, and fewer revascularization strategies, resulting in poorer outcomes. This case highlights the unique risk factors and diagnostic challenges in women with PAD, which contribute to healthcare disparities.