Ng Claire, Ng Adrian, Ong Keh Oon, Sinnasamy Moorthy
Radiology, Aberdeen Royal Infirmary, Aberdeen, GBR.
Radiology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, GBR.
Cureus. 2025 Sep 21;17(9):e92832. doi: 10.7759/cureus.92832. eCollection 2025 Sep.
Lower limb claudication is a common symptom with diverse aetiologies, most frequently neurogenic or vascular in origin. Identifying and discerning between these causes is essential, especially in patients with cardiovascular risk factors, as misdiagnosis may lead to suboptimal treatment. Dual pathology, though rare, can pose a significant diagnostic challenge. We report a case of a 60-year-old male farmer with a history of coronary artery disease who presented with progressive bilateral lower limb claudication and lumbosacral back pain. MRI spine revealed a right L4-L5 facet joint synovial cyst causing central spinal canal stenosis, while CT angiography demonstrated bilateral critical femoral artery stenoses. He underwent a percutaneous CT-guided facet joint synovial cyst rupture, which provided partial symptom relief, mainly from neurogenic claudication. Despite this, he still experienced persistent exertional claudication. He subsequently underwent staged endovascular revascularisation of the femoral arteries under Interventional Radiology, resulting in complete resolution of symptoms. At the three-month follow-up, he remained asymptomatic and had returned to his baseline physical function. This case highlights the diagnostic challenges associated with claudication when neurogenic and vascular features overlap and demonstrates that although the coexistence of neurogenic and vascular claudication is uncommon, it should be considered in patients presenting with atypical or refractory symptoms. In this particular case, a sequential percutaneous approach, addressing the spinal pathology first, followed by vascular insufficiency, resulted in excellent functional outcomes. These findings emphasise the importance of thorough clinical assessment and appropriate imaging in identifying the aetiology, thus preventing misdiagnosis. In addition, it also demonstrates that staged, minimally invasive radiological interventions can obviate the need for open surgery whilst still achieving complete symptom resolution and restoration of function.
下肢间歇性跛行是一种常见症状，病因多样，最常见的起源是神经源性或血管性。区分这些病因至关重要，尤其是对于有心血管危险因素的患者，因为误诊可能导致治疗效果不佳。双重病理情况虽然罕见，但可能带来重大的诊断挑战。我们报告一例60岁男性农民，有冠状动脉疾病史，表现为进行性双侧下肢间歇性跛行和腰骶部疼痛。脊柱MRI显示右侧L4-L5小关节滑膜囊肿导致中央椎管狭窄，而CT血管造影显示双侧股动脉严重狭窄。他接受了经皮CT引导下的小关节滑膜囊肿破裂术，部分症状得到缓解，主要是神经源性间歇性跛行症状。尽管如此，他仍有持续的运动性跛行。随后，他在介入放射科接受了分期的股动脉血管腔内血运重建术，症状完全缓解。在三个月的随访中，他无症状，身体功能恢复到基线水平。 本病例突出了神经源性和血管性特征重叠时与间歇性跛行相关的诊断挑战，并表明尽管神经源性和血管性间歇性跛行同时存在并不常见，但对于出现非典型或难治性症状的患者应予以考虑。在这个特殊病例中，采用先处理脊柱病变，再处理血管功能不全的序贯经皮方法，取得了极佳的功能结果。这些发现强调了全面临床评估和适当影像学检查在确定病因、防止误诊方面的重要性。此外，它还表明分期的微创放射学干预可以避免开放性手术，同时仍能实现症状完全缓解和功能恢复。
