Aortic flap valve presenting as neurogenic claudication: a case report.

STUDY DESIGN A case report of a patient who presented with pain in both lower limbs related with walking and standing as a result of an unusual vascular etiology. OBJECTIVES To describe the pathology and treatment of an unusual case of vascular claudication. SUMMARY OF BACKGROUND DATA Symptoms of neurogenic claudication may be mimicked by intermittent vascular claudication. Not infrequently, arterial disease coexists with spinal canal stenosis. Determination of correct diagnosis is the prerequisite for effective treatment. METHODS The patient was a 64-year-old woman who presented with bilateral buttock pain spreading to the calves. The symptom was related to walking and climbing stairs and relieved by sitting down. MRI of the lumbosacral spine corroborated severe spinal stenosis at L3-L4 and L4-L5. Based on findings on physical examination of the peripheral pulses, an aortogram revealed a flap in the lumen functioning like a valve as the cause of her lower limb ischemic pain. RESULTS The patient was managed by insertion of a self-expandable metallic stent with complete resolution of her symptoms. CONCLUSIONS We report a case that was diagnosed as neurogenic claudication on clinical features and MRI evidence. However, subsequent to an aortogram the diagnosis was revised. Intermittent claudication is often difficult to distinguish from neurogenic claudication. There are no sensitive discriminators based on history alone. In the presence of poor or absent peripheral pulses, an arteriogram is necessary to ascertain the relative importance of the peripheral arterial circulation.