Abstract
INTRODUCTION AND IMPORTANCE: Coral-reef type aortic occlusions are uncommon conditions that can result in intermittent claudication. Many claudicants also have concomitant neurogenic aetiologies and revascularization alone may not be beneficial. These cases can prove to be a diagnostic challenge. CASE PRESENTATION: We present a case of worsening bilateral calf claudication in a patient with previously asymptomatic coral-reef type aorta, anxiety, and spinal stenosis presents. Investigations were unable to differentiate between a neurogenic and vascular cause. The patient opted for aortic stenting before spinal surgery, after extensive discussion. Initial attempts at crossing the occluded segments were unsuccessful and the patient was offered the option to either resume conservative therapy, perform an open axillo-bifemoral bypass or repeat aortic stenting. After discussion, a repeat aortic stenting was performed. This time, the stenting attempt was successful, with completion angiogram showing brisk antegrade flow and strong distal pulses returned. Post-surgery, the patient's symptoms improved vastly. CLINICAL DISCUSSION: Differentiation of vascular claudication from neurogenic claudication is diagnostically challenging. Decision to treat the aorta or the spinal issue first depend on the patient's constellation of symptoms. CONCLUSION: Endovascular aortic stenting is well accepted with good results and lower morbidity than open surgery. A repeat attempt is always a possible option.