A 38-year-old male smoker presented with a 1-year history of left-calf discomfort during ambulation and a 3-month history of progressive bluish discoloration of the toes. He had previously been seen by a vascular surgeon and diagnosed with a 'near' occlusion of the tibioperoneal trunk. Physical examination revealed diminished radial artery pulses bilaterally, and the Allen test was positive bilaterally. Tender subcutaneous nodules on the medial aspect of the left calf and a mottled appearance of the skin on the bilateral lower extremities were noted. Computed tomographic (CT) angiography displayed stenosis within the tibioperoneal trunk as well as the infrageniculate arteries bilaterally. Additionally, characteristic "corkscrewing" of distal tibioperoneal and digital arteries was identified. Duplex ultrasonography documented segmental thrombosis of the left great saphenous vein.