Het koraalrifsyndroom: een thoracale aortastenose als verklaring voor een verzameling van symptomen

A woman aged 61 presented with intermittent claudication of both lower extremities. Her walking range was less than 100 m. An aortobifemoral prosthesis was placed due to atherosclerosis at the level of both common iliac arteries. The intermittent claudication recurred repeatedly, and several interventions to alleviate this problem were performed without success. Eventually the intermittent claudication was found to be due to a highly calcified stenosis of the thoracic aorta. Meanwhile, the patient was treated for essential hypertension, mild chronic renal insufficiency and gastrointestinal angiodysplasias with iron deficiency anaemia. A thoracic aorta stenosis is a rare cause for intermittent claudication, and is frequently observed in combination with hypertension, renal insufficiency and abdominal angina, also known as the coral reef syndrome. All symptoms in our patient disappeared following an endarterectomy, including blood loss due to the gastrointestinal angiodysplasia. The latter phenomenon also occurs in Heyde’s syndrome, a combination of a aortic valve stenosis and gastrointestinal angiodysplasia.