Leriche Syndrome

Definition

Aorto-iliac occlusive disease also refers to Leriche syndrome that involves total blockage of distal aorta on its way to renal arteries. Blood is carried by the aorta as the main artery from the heart going to the body. The aorta proceeds downwards coming from the heart to the abdomen.

The main artery will then divide into two, known as the common iliac arteries as it reaches its end. Both arteries contribute blood to the groin areas, lower limbs, and buttock. In Leriche syndrome, there is a complete occlusion in the lower area of the aorta before the beginning point of the two arteries. In return, supply of blood to the lower limbs and groin are decreased.

Symptoms of Leriche Syndrome

A patient with Leriche’s syndrome manifests a variety of symptoms that resulted from a certain kind of peripheral arterial disease; where blood flow occlusion is happening in the aorta in the stomach region, in the legs, and among males, its affecting blood flow going to the penis.

Symptoms of Leriche’s syndrome may include:

• Buttock claudication – This is when a person feels pain or cramps on the buttock area when walking or exercising
• Sexual impotence – Failure to achieve an erection in men
• Weak pulses in the lower limbs
• Weakness or numbness of the leg
• Fatigue
• Cold and pale feet and legs

In severe cases of Leriche’s syndrome, it include the 6ps:

• Prostration
• Pain
• Paralysis
• Pallor
• Pulselessness
• Parasthesia

Causes

Some causes of Leriche syndrome may include:

• Atherosclerosis – It is a disease of the arteries that is caused by an atherosclerotic blockage of aortoiliac arteries
• Vasculitis – It is an inflammation of blood vessels.
• Thrombosis – Local clotting of the blood in an area of the circulatory system

Diagnosis

Examinations used in the workup and diagnostic examinations of Leriche syndrome include:

• Blood Tests – To measure the lipid levels in the blood and other blood tests that could be useful in diagnosing the condition.
• CT Angiography – This examination combines an injection of a contrast media and a computed tomography scan to form images of tissues and blood vessels in an area of the body. This is typically the best assessment tool that can be used. It can show a direct visualization of the site of the occlusion and stenosis.
• MR Angiography (MRA) – This test helps by diagnosing plaque disease or recognizing certain abnormalities and examines blood vessels. It is also for patients where CT angiography is not possible.

Treatment

Leriche’s syndrome treatment involves the following:

Identification and treatment of risk factors – Conditions such as high lipid levels, diabetes, and hypertension must be treated and smoking should also be stopped.

Antiplatelet medications – These medications should be received by a patient to prevent blood clotting and other complications such as stroke and heart attack.

Walking exercise program – Doing this kind of program can help the patient enhance the oxygen utilization by the muscles on a period of time.

Medications – Cilostazol and Pentoxyfyline could help a patient with the symptoms of claudication.

Surgery – This is needed to remove a clot or to bypass it.

Percutaneous transluminal angioplasty (PTA) – This is a less invasive method and may be used as a substitute particularly for patients who are at risk of complications if an open surgery is done.

References:

1. http://www.medindia.net/patients/patientinfo/leriche-syndrome.htm
2. http://www.webmd.com/a-to-z-guides/leriches-syndrome-topic-overview
3. http://radiopaedia.org/articles/leriche-syndrome
4. Krankenberg H, Schlüter M, Schwencke C, Walter D, Pascotto A, Sandstede J, Tübler T (2009). Endovascular reconstruction of the aortic bifurcation in patients with Leriche syndrome. Clin Res Cardiol. 98(10):657–664.
5. Lipetz, J.S., Beer, J.R., Silber, J.S (2004). Atypical proximal limb pain of suspected high lumbar stenotic origin arising from severe aortoiliac disease—Leriche’s syndrome. Pain Physician. 7:123–128.
6. Diehm C, Schuster A, Allenberg JR, Darius H, Haberl R, Lange S, Pittrow D, Stritzky B, Tepohl G, Trampisch HJ (2004). High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 172(1):95–105.