LEA 14. Bilateral Lower Limb Disabling Claudication in a Young Man: Mönckeberg Arteriosclerosis, What to Do?

Abstract

Mönckeberg arteriosclerosis is called medial calcific sclerosis, which is a form of vessel hardening due to increased calcium deposits in the tunica media layer. Its clinical significance and etiology and its relation to atherosclerosis and vascular calcification are still a matter of disagreement. Its clinical presentations and the treatment are still debatable. The aim of this article was to focus on a special pathologic entity that the vascular surgeon could encounter and that could be a limb-threatening and consequently life-threatening condition. In our reported case, a 22-year-old, average-build young man reported repeated muscle cramps and fatigue with heavy exercise that were relieved by rest. The condition was then neglected by him but increased later, and bilateral claudication pain with increased duration of pain was noticed with regular exercise. The patient was fully investigated by laboratory and radiologic study. Computed tomography angiography showed extensive calcification affecting the vasculature of both lower limbs bilaterally (mirror images anatomically; Figs 1 and 2). The patient is under medical treatment and follow-up as of the writing of this case More effort should be expended in an attempt to distinguish between atherosclerotic lesions and Mönckeberg lesions on the basis of age predominance and location. The pattern of calcifications had considerable overlap between intima and media and involved the internal elastic lamina border between those planes.Fig 2Extensive calcification in popliteal and infragenicular arteries, bilaterally.View Large Image Figure ViewerDownload Hi-res image Download (PPT)