1. A diagnostic dilemma following aortic stenting

2. 69 year old male 2005: Weakness & pallor of both legs

3. 69 year old male 2005: Weakness & pallor of both legs PMH: –Ex smoker –CABG 1995 –Hypertension –Closed pelvic  1953

4. 69 year old male 2005: Weakness & pallor of both legs PMH: –Ex smoker –CABG 1995 –Hypertension –Closed pelvic  1953 O/E: –Weak femoral pulses Duplex: –Stenosis of infra-renal aorta. ABPI 0.85 (R) & 0.73 (L)

5. Angiogram

6. Endovascular aortic stent Sept 2005

7. Oct 2005 –Claudication alleviated –Debilitating bilateral buttock pain on sitting for >5 mins –No bladder outflow obst n. No sensory loss. Post-operative course

8. Oct 2005 –Claudication alleviated –Debilitating bilateral buttock pain on sitting for >5 mins –No bladder outflow obst n. No sensory loss. Post-operative course Possibilities: Pelvis ischaemia / gluteal compartment syndrome Neuropathic / spinal ischaemia Colorectal Soft tissue / pelvic sepsis

9. Oct 2005 –Claudication alleviated –Debilitating bilateral buttock pain on sitting for >5 mins –No bladder outflow obst n. No sensory loss. Supine and flexion angiograms Colorectal review / flex sigmoidoscopy MR Lumbar-sacral spine Neurology review Post-operative course Normal

10. Pelvis ischaemia / gluteal compartment syndrome Neuropathic / spinal ischaemia Colorectal Soft tissue / pelvic sepsis Possibilities WILL STENT REMOVAL BE BENEFICIAL?