Intermittent claudication caused by small aorta syndrome: a case report and review of literature

Abstract

Aortoiliac arterial steno-occlusions in young or middle-aged patients are relatively rare and have been reported in the literature as small aorta syndrome (SAS) or hypoplastic aortoiliac syndrome. We report the case of a 48-year-old Japanese woman with intermittent claudication caused by SAS. We performed left iliofemoral bypass grafting with a Dacron graft via a retroperitoneal approach. Bypass grafts, endarterectomy, and sympathectomy have been used for surgical management. Given that post-procedural event rates are higher for SAS than for other common atherosclerotic diseases, patients with SAS should be closely followed up after surgery.

Keywords: hypoplastic aortoiliac syndrome; intermittent claudication; small aorta syndrome.

Fig. 1

Contrast-enhanced three-dimensional computed tomography angiography revealing no atherosclerotic change from the abdominal aorta to both femoral arteries but showing occlusion of the left external iliac artery. Furthermore, the level of aortic bifurcation is high with a narrow angle (White arrows indicate occlusion of the left external iliac artery).

Fig. 2

Microscopic examination with elastica van Gieson staining: (1) thrombus-occluded internal vessel occlusion; (2) thickened intima; (3) disrupted and/or diminished elastic fiber of the media; (4) longitudinally arranged adventitial smooth muscle cells.