84 year old female with history of HTN, type 2 DM, coronary artery disease and CKD. She was evaluated in clinic for complaints of pain in right forefoot at night which was relieved with dependency. On examination she had dependent rubor and monophasic right DP and PT signal. Her home medications include Aspirin 81 mg/day, Clopidogrel 75 mg/day and atorvastatin 20 mg qhs. Arterial duplex done in clinic showed total occlusion of right PT and AT in the midsegment.