A 68-year-old woman with a 15-year history of poorly controlled hypertension presents to the emergency department with acute onset of left leg pain and coldness that began 2 hours ago. She reports no preceding trauma or prolonged immobility. Vital signs: BP 168/94 mmHg, HR 102/min, RR 18/min, T 37.2°C. Physical examination reveals pallor of the left foot, absent left femoral and distal pulses, but palpable right femoral pulse. Abdominal examination reveals a pulsatile epigastric mass without tenderness. CT angiography of the abdomen and pelvis shows a 5.5 cm infrarenal abdominal aortic aneurysm with an eccentric mural thrombus and no active extravasation. Laboratory studies: hemoglobin 9.8 g/dL, WBC 8.2 k/µL, creatinine 1.4 mg/dL. Which of the following is the most likely diagnosis explaining her acute presentation?

1. A)Acute aortic dissection with branch vessel involvement
2. B)Thrombosis of an iliac artery bifurcation secondary to aortic mural thrombus embolizationGABARITO
3. C)Acute left femoral artery thrombosis from in-situ thrombosis
4. D)Ruptured abdominal aortic aneurysm with contained hemorrhage
5. E)Acute mesenteric ischemia from celiac artery compression