Results
Patient 1 : An 81-year-old woman presented with a 50-year history of joint pain in her legs. She underwent bilateral distal bypass surgeries at 72 years of age for intermittent claudication. Plain radiography of the lower extremities revealed significant calcification with areas of arteriomegaly. Three-dimensional computed tomography revealed extensive occlusion of the bilateral femoropopliteal arteries with aneurysmal changes and severe calcifications, which are typical findings of CALJA (Fig. 1A). The patient’s saphenous vein grafts were patent when she presented to us. During her recovery from the vascular reconstructive surgeries, the patient gradually developed exertional fatigue. Echocardiography revealed severe aortic valve stenosis with a peak pressure gradient of 50 mmHg. AVR was performed when the patient was 77 years old. The native aortic valve was tricuspid and the valvular leaflets and annulus showed significant calcification (Fig. 1B). However, no calcification was observed in the aortic wall. She underwent AVR with a Carpentier-Edwards PERIMOUNT bioprosthetic valve (Edwards Lifesciences, Irvine, CA) (Fig. 1C). Her postoperative course was uneventful.
Patient 2 : A 74-year-old woman, who is the younger sister of Patient 1, reported a 10-year history of bilateral intermittent claudication of the calves and chronic coldness of her lower extremities. At 71 years of age, she had developed dyspnea on exertion and was diagnosed with severe aortic valve stenosis with a peak pressure gradient of 90 mmHg. Her native aortic valve was tricuspid with severe calcification of the cusps and annulus (Fig. 2A). There were no calcified lesions in the aortic wall. She underwent an AVR with a Solo Smart stentless bioprosthesis (LivaNova PLC, London, UK) (Fig. 2B). She recovered from the operation well; however, the intermittent claudication in her calves gradually worsened. Three-dimensional computed tomography revealed occluded aneurysmal femoropopliteal arteries with severe calcification (Fig. 2C), which are typical of CALJA and were similar to the calcifications that had been found in her sister’s lower extremities. She underwent bilateral distal bypass surgeries for claudication at the age of 73 years.
Currently, both patients are doing well after several cardiac and vascular operations.