Hip Claudication—Its Pathophysiology and Treatment

Abstract

Hip claudication (HC) is a comparatively rare symptom in patients with chronic arterial occlusive disease. Although the role of the internal iliac artery (IIA) is important in the occurrence of HC, the relationship between HC and the IIA collateral system with the external iliac artery and the superior rectal artery is not clear and is possibly very complex. During the past three years 15 patients who presented with HC, and 3 patients who presented with bilateral IIA occlusion without HC, were studied. In all patients angiography revealed variable IIA occlusive changes. The pressure in the bilateral profunda penis arteries was measured and was found to correspond well with the angiographic findings. The superior rectal arterial flow was examined transrectally with a Doppler probe developed by the authors. In addition to the main arterial recon struction (bifurcated synthetic grafting 8 cases, femorofemoral crossover or fe moropopliteal bypass 6 cases, etc.), direct IIA reconstruction was performed in 13 IIAs (8 patients) with good results. HC was removed in 2 of the 3 femorofe moral crossover bypass cases.

Their study suggests that many variations of hip claudication exist. The pe nile brachial pressure index in HC patients was 0.3±0.13 or less. Bilateral IIA occlusion cases with no HC were found to be getting blood via the superior rectal artery. It was also observed that there were to a certain extent independ ent supplies to the hip and genitalia, for elevation of the penile pressure was seen on the IIA repair side. In some cases, without IIA repair, the rich blood plexus to the pelvic organs via the iliac circumflex and others provided complete relief from hip claudication.

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