First-pass radionuclide angiography of the terminal aorta was performed in 3 normal horses and a 6-year-old Standardbred intact male with aortoiliac thromboembolism. Thromboembolism caused chronic bilateral hind limb lameness, more severe in the right hind limb, was detected by rectal examination, and confirmed using transrectal ultrasonography. Using 99mTc-HDP, first-pass radionuclide angiography was combined with hind limb and pelvis bone (delayed) scintigraphy and revealed marked reduction in blood flow through both external iliac arteries and absence of blood flow in the internal iliac arteries. Quantitative analysis showed a decreased activity in the right iliac vessels in the clinic patient consistent with reduced blood flow when compared to control horses. First-pass radionuclide angiography provided a method to obtain diagnostic images of the terminal aorta and branches and a method to diagnose aortoiliac thromboembolism in the horse.