Objective:

To describe progressive coral reef aorta causing severe lower-extremity ischemia in a patient whose symptoms were initially attributed to lumbar disc herniation.

Approach:

• Case and assessment: Researchers reported a 50-year-old man with smoking, hypertension, and hyperlipidemia, reviewing six years of CT scans alongside clinical examinations and ankle-brachial index (ABI) measurements.
• Treatment and follow-up: Because extensive aortic calcification made endovascular treatment unsuitable, the patient underwent open aortic graft replacement with inferior mesenteric artery reconstruction. Clinical status, ABI, and contrast-enhanced CT were assessed through one year.

Key Findings:

• Bilateral leg numbness had been attributed to lumbar disc herniation four years earlier; the patient later developed claudication and severe rest pain.
• ABI at presentation was 0.49 in both legs, compared with 0.99 on the right and 1.07 on the left six years earlier.
• CT showed dense calcified plaques extending more than 4 cm along the infrarenal aorta and causing near occlusion; earlier scans showed progressive calcification.
• After surgery, symptoms resolved and ABI improved to 1.13 on the right and 1.19 on the left by postoperative day four.
• At one year, the patient remained asymptomatic, ABI was 1.07 bilaterally, and CT showed patent graft and reconstructed artery.

Interpretation:

The authors noted that coexisting lumbar disc herniation may have masked the vascular disorder. They stated that coral reef aorta should be considered in unexplained progressive bilateral lower-extremity ischemia and that treatment selection should reflect anatomy and patient risk.

Limitations:

• The single-patient report cannot establish comparative effectiveness of open surgery versus endovascular treatment.
• The extent to which the initial diagnosis delayed recognition of vascular disease could not be determined definitively.
• One-year follow-up does not establish longer-term graft durability or risk of recurrent vascular complications.

Conclusion:

Serial CT documented progressive aortic calcification and informed treatment selection in this case. The authors reported no conflicts of interest or funding.

Sources:

• European Heart Journal–Case Reports