When collateral vessels matter: asymptomatic Leriche syndrome

Leriche syndrome: Clinical and diagnostic approach of a rare infrarenal aortoiliac occlusive disease

Leriche syndrome is an aortoiliac occlusive arterial disease comprising decreased peripheral pulses, claudication, and erectile dysfunction. We present a case of a 60-year-old male with abdominal pain and hematochezia who was diagnosed with hemorrhoids. The patient also had associated leg cramps on both sides and lower limb weakness. Further evaluation of the patient with imaging revealed occlusion of the distal descending abdominal aorta below the level of renal arteries and the iliac arteries. An incidental finding of Leriche syndrome was evident. This case report contributes to the current literature when any patient with abdominal pain and bilateral lower limb weakness, Leriche syndrome should be considered to avoid complications as it has high morbidity and mortality.

A Patient With Foot Pain Found to Have Leriche Syndrome: A Case Report and Brief Review of the Literature

Leriche syndrome, a rare and critical complication of peripheral arterial disease (PAD), affects the distal abdominal aorta (infrarenal) and, similar to PAD, is a result of plaque buildup in the arterial lumen. The Leriche syndrome triad includes claudication in the proximal lower extremity, decreased or absent femoral pulses, and, in some cases, impotence. This article presents a patient with an atypical presentation of foot pain who was subsequently found to have Leriche syndrome. The patient was a 59-year-old female, a former smoker, who presented to the emergency department (ED) with atraumatic, acute right foot pain. All right lower extremity pulses were faintly audible on bedside Doppler. Computed tomography with angiography of the abdominal aorta revealed a Leriche-type occlusion of the infrarenal abdominal aorta and left common iliac and a 10 cm right popliteal arterial occlusion. Pharmacological anticoagulation was initiated by the ED. Definitive treatment in this patient included catheter-directed tissue plasminogen activator lysis to the thrombus on the right and placement of kissing stents in the distal aorta without complication. The patient made an excellent recovery and had a complete resolution of her symptoms. PAD is an omnipresent condition and, when untreated, can result in a myriad of high mortality and morbidity conditions such as Leriche syndrome. Collateral vessel formation can make the symptoms of Leriche syndrome vague and inconsistent, often making early recognition difficult. Optimal outcomes hinge on the clinician's ability to efficiently recognize, diagnose, stabilize, and coordinate multidisciplinary involvement of vascular and interventional radiology specialties. Case reports such as this one help to illuminate some of the more infrequent presentations of Leriche syndrome.

When the aortoiliac bifucation is occluded:Leriche syndrome

Intoduction

Leriche syndrome is a special type of obliterating arterial disease of the lower limbs which results in thrombotic occlusion of the aortoiliac junction.

Case report

We report the case of a 65-year-old patient with known cardiovascular and nephrological pathological history, who presented with acute abdominal pain with intermittent claudication of the lower limbs and in whom clinical examination found abolition of the femoral pulses.

Discussion

Doppler ultrasound of the abdominal aorta revealed aortic thrombosis in the lower of the renal segment extended to the iliac bifurcation with damping of upstream circulatory speeds. We supplemented with a CT angiography of the aorta and lower limbs which demonstrated extensive arterial thrombosis from the abdominal aorta to the bilateral external iliac arteries.

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Leriche syndrome is a special type of obliterating arterial disease of the lower limbs.

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It's Responsible of a unique triad of symptoms, including claudication, impotence, and decreased peripheral pulses.

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The diagnosis is suspected clinically, objectified by Doppler ultrasound and detailed by CT angiography.

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CT angiography is the examination of choice in the diagnosis of Leriche syndrome.

Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature

Background

Both acute myocardial infarction and acute pulmonary embolism are distinct medical urgencies while they may conincide. Leriche’s syndrome is a relatively rare aortoiliac occlusive disease characterized by claudication, decreased femoral pulses, and impotence. We present the first case of concomitant acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome.

Case presentation

A 56-year-old male with a history of intermittent claudication was admitted for evaluating the sudden onset of chest pain. Elevated serum troponin level, sustained high D-dimer level, ST-T wave changes on electrocardiogram, and segmental wall motion abnormality of the left ventricle on transthoracic echocardiography were noted. Pulmonary Computed Tomography Angiogram revealed multiple acute emboli. Aortic Computed Tomography Angiogram spotted complete obstructions of the subrenal aorta and bilateral common iliac arteries with collateral circulation, maintaining the vascularization of internal and external iliac arteries. We stated the diagnosis of acute pulmonary embolism and Leriche syndrome and initiated oral anticoagulation. However, Q waves on electrocardiogram and wall motion abnormality on echocardiography persisted after embolus dissolved successfully. Coronary computed tomography angiogram found coronary arterial plaques while myocardial Positron Emission Tomography detected decreased viable myocardium of the left ventricle. We subsequently ratified the diagnosis of concurrent acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome. The patient was discharged and has been followed up at our center.

Conclusion

We described the first concurrence of acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome.