58 year old male, current smoker (1.5 packs per day), HTN and non insulin dependent diabetes. Presented with complaints of worsening left calf claudication x 1 month. Noticed rest pain requiring opioids x 15 days. Had an angiogram done at outside facility and was recommended for bypass surgery. Patient came in for second opinion and possible endovascular options. Duplex done at Mount Sinai Hospital, suggestive of low velocity monophasic flow in left CFA and area of ? significant stenosis in left distal SFA.