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.