Intermittent claudication 1 yr. following AAA

[Karla__0]

  My husband was having intermittent claudication 1 yr. ago...and imaging
  studies revealed a 6 cm abdominal aortic aneurysm.  This was repaired and a Vanguard Hemashield graft was used thru abdominal surgery.  At the time they debated whether they needed to extend the graft down to include the iliac arteries, but decided against it.  He has had recurrent claudication
  pain in the calves and hips after walking a distance of about a half of a block.  They repeated several imaging studies and found a kink in the graft from the AAA. They have been puzzled over this finding and have been unable to determine if this is the cause of his recurrent claudication.  They found that the iliac narrowing had increased and hence decided to balloon and stent the iliacs.  This was done 2 weeks ago, and he still has claudication pain.  We are to follow up with them after the 1st of the year.  They feel that this kink is not causing a problem....during the cath. procedure they measured it and it was 13 mm at kink and 23 above and below it.  Lying there he had no changes in pressure when they measured it, but he didn't have pressure changes or pain at rest in his lower extremities when they measured it either.  I am concerned about the long term sequelae of this 'kink' and if it can be fixed by means other than going thru the AAA repair all over again.  Is there any imaging or other diagnostic study to measure the pressures around this when he is experiencing the pain.  I'm sorry this is so wordy.....but I felt this was all relevant.  He is 58 with 1 yr. history of hypertension, smoker, fairly sedentary lifestyle, but in good health until all this began 1 yr. ago
  Thank you for you expertise....
  Karla

[CCF CARDIO MD APS]

_
Dear Karla,
Direct Doppler measurement of the pressures in the graft can be meaured with a Doppler wire as it is pulled back through the stenosis; this is the most invasive way.  Such Dopper wires were designed to measure pressures directly in the coronary arteries and I can not be sure if they would be so accurate, however this is one of the questions I will ask our vascular specialists here at the Cleveland Clinic.  Other questions I will ask are: 1. Can some kind of stent be placed inside the graft or is that too dangerous? 2. At what point would you reoperate such that the benefits outweighed the risks of reoperation?
I will get back to you in the next two days when I get a consensus opinion; we have cardiologists here at the Cleveland Clinic who also do peripheral vascular procedures, but not surgeries.  I think that you know Karla that this is a very unique case and must be approached as such, I will get back to as soon as possible.
I hope this information is useful. Information provided in the heart forum is for
general purposes only.  Only your physician can provided specific diagnoses and therapies.
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