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Cureus May 2023Leriche syndrome, a rare and critical complication of peripheral arterial disease (PAD), affects the distal abdominal aorta (infrarenal) and, similar to PAD, is a result...
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.
PubMed: 37332424
DOI: 10.7759/cureus.39199 -
BMC Cardiovascular Disorders Sep 2021Aortoiliac occlusion disease, also called Leriche syndrome, is characterized by atherothrombotic obliteration of the aortic bifurcation and bilateral common iliac...
BACKGROUND
Aortoiliac occlusion disease, also called Leriche syndrome, is characterized by atherothrombotic obliteration of the aortic bifurcation and bilateral common iliac arteries; typically, it has a chronic presentation. Pulmonary embolism is more related to venous thromboembolism rather than arterial thromboembolic events. Therefore, cases of simultaneous acute Leriche syndrome and pulmonary embolism are rare. Existing intracardiac right-to-left shunt were detected in most previous cases. Herein, we present the first likely documented case wherein acute Leriche syndrome and pulmonary embolism occurred simultaneously without a patent foramen ovale.
CASE PRESENTATION
A 58-year-old man with hyperlipidemia and coronary artery disease presented with a 4-h history of bilateral lower limb numbness. He was a heavy smoker with a history of stroke. Computed tomography angiography revealed pulmonary embolism and aortoiliac artery occlusion. Although a massive thrombus straddled the bilateral pulmonary arteries, orthopnea was his only presentation, without right ventricle failure. Cyanosis of the affected limbs was noted, and muscle strength in both limbs had regressed to grade 1. Owing to acute limb ischemia, he underwent an emergency operation to salvage the limbs. On postoperative day 5, the general condition of both the legs improved; the muscle strength improved to grade 4. He was then transferred to the general ward and enoxaparin was continued. Computed tomography angiography was repeated to evaluate the pulmonary embolism on postoperative day 8; the thrombus remained lodged in the bilateral main pulmonary arteries. Owing to persistent orthopnea and chest tightness with intermittent tachycardia, he underwent a staged operation for the pulmonary embolism on postoperative day 13. During the surgery, intraoperative transesophageal echocardiography showed no patent foramen ovale or an existing right-to-left shunt. Postoperatively, he was closely monitored in the intensive care unit for 3 days and then transferred to the general ward for 10 days. A final computed tomography angiography performed on postoperative day 18 revealed thrombus resolution. He was then discharged on postoperative day 30 without any in-hospital complications.
CONCLUSION
We present a case that might be the first documented report of acute Leriche syndrome co-occurring with pulmonary embolism without an existing patent foramen ovale.
Topics: Humans; Ischemia; Leriche Syndrome; Limb Salvage; Lower Extremity; Male; Middle Aged; Pulmonary Embolism; Recovery of Function; Regional Blood Flow; Treatment Outcome; Vascular Surgical Procedures
PubMed: 34565333
DOI: 10.1186/s12872-021-02272-3 -
Annals of Rehabilitation Medicine Feb 2014The syndrome of aortoiliac occlusive disease, also known as Leriche syndrome, is characterized by claudication, pain, and diminished femoral pulse. We highlight an...
The syndrome of aortoiliac occlusive disease, also known as Leriche syndrome, is characterized by claudication, pain, and diminished femoral pulse. We highlight an unusual case of right sciatic neuropathy caused by Leriche syndrome, which was initially misdiagnosed. A 52-year-old male, with a past medical history of hypertension and bony fusion of the thoracolumbar spine, visited our hospital complaining of right leg pain and claudication, and was initially diagnosed with spinal stenosis. The following electrophysiologic findings showed right sciatic neuropathy; but his symptom was not relieved, despite medications for neuropathy. A computed tomography angiography of the lower extremities revealed the occlusion of the infrarenal abdominal aorta, and bilateral common iliac and right external iliac arteries. All these findings suggested omitted sciatic neuropathy associated with Leriche syndrome, and the patient underwent a bilateral axillo-femoral and femoro-femoral bypass graft.
PubMed: 24639938
DOI: 10.5535/arm.2014.38.1.132 -
Journal of Veterinary Internal Medicine Mar 2022Aortic and aortoiliac thrombosis in dogs causes disease and death.
BACKGROUND
Aortic and aortoiliac thrombosis in dogs causes disease and death.
OBJECTIVE
To describe the procedure and outcomes for stenting the caudal aorta and aortoiliac trifurcation.
ANIMALS
Seven client-owned dogs that underwent aortic/aortoiliac stenting for treatment of thrombosis.
METHODS
Retrospective multi-center investigation. Medical records were reviewed for dogs that underwent stenting of the aorta or aortoiliac trifurcation between 2008 and 2020. Information collected included history, signalment, clinicopathologic data, diagnostic imaging, procedure reports, and outcomes.
RESULTS
Seven dogs with an occlusive thrombus located at or near the aortic trifurcation were included. Four of 7 dogs were non-ambulatory. Hind limbs were paretic in 5 dogs, paralyzed in 1 dog, and claudication alone was noted in 1 dog. Five of the 7 dogs had protein-losing nephropathy (PLN). Of 5 dogs with PLN, 1 had protein-losing enteropathy (PLE) and controlled hypothyroidism and 1 had caudal aortic chondrosarcoma. Two dogs had no identified underlying disease. Angiography was performed before catheter directed thrombolysis and stent placement. No deaths occurred during the procedure. Postoperative complications included pain (4/7), bruising and edema (3/7), bruising only (1/7), and edema only (1/7). Median survival time (MST) of the 7 dogs was 264 days (range, 1-1053 days). Five of 7 dogs were ambulatory within 2 days of stenting and survived to discharge with a MST of 425 days (range, 208-1053 days).
CONCLUSIONS AND CLINICAL IMPORTANCE
Stenting of the aorta and aortoiliac trifurcation can provide an apparently safe and effective treatment with rapid return to ambulation for some dogs with aortic thrombosis.
Topics: Animals; Aorta; Aortic Diseases; Dog Diseases; Dogs; Retrospective Studies; Stents; Thrombosis; Treatment Outcome
PubMed: 35129219
DOI: 10.1111/jvim.16359 -
Journal of Education & Teaching in... Jan 2022Aortoiliac occlusive disease (AOD) is a manifestation of peripheral arterial disease characterized by stenosis or occlusion of the distal aorta and iliac vessels....
UNLABELLED
Aortoiliac occlusive disease (AOD) is a manifestation of peripheral arterial disease characterized by stenosis or occlusion of the distal aorta and iliac vessels. Advanced disease may present with symptoms of claudication to the buttock and thighs, erectile dysfunction, and absent or diminished femoral pulses bilaterally. Here, we discuss a case of a 71-year-old male who presented with acute bilateral lower extremity pain and weakness. Pulses were undetectable bilaterally at the groin prompting emergent imaging and vascular surgery consultation due to the suspected diagnosis of AOD. The patient was taken for bilateral femoral artery cut downs with embolectomy. The patient made an impressive recovery with preservation of motor function of lower extremities. In this case report we discuss pertinent workup and management of a patient suspected to be suffering from AOD.
TOPICS
Vascular, arterial thrombosis, limb ischemia, aortoiliac arterial thrombosis, Leriche syndrome, peripheral arterial disease.
PubMed: 37483394
DOI: 10.21980/J87M0Z -
Indian Journal of Ophthalmology Jun 2020
Topics: Humans; Leriche Syndrome; Retinal Diseases; Retinal Vein Occlusion
PubMed: 32461464
DOI: 10.4103/ijo.IJO_1784_19 -
Clinical Case Reports Sep 2021Transcarotid percutaneous coronary intervention is feasible and safe and can be considered as an ultimate alternative in cases where conventional peripheral vascular...
Transcarotid percutaneous coronary intervention is feasible and safe and can be considered as an ultimate alternative in cases where conventional peripheral vascular access is unavailable.
PubMed: 34484772
DOI: 10.1002/ccr3.4739 -
Folia Biologica 2017Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play a complex role in the pathogenesis of atherosclerosis. We compared (1) the histopathological...
Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play a complex role in the pathogenesis of atherosclerosis. We compared (1) the histopathological findings in patients with abdominal aortic aneurysms (AAA) and aortoiliac occlusive disease (AOD); (2) the expression of MMP-2/MMP-9 and TIMP-1/TIMP-2 in aortic layers, inflammatory cells and smooth muscle cells (SMCs), aiming to identify the common underlying pathogenic mechanisms of the disease development. Samples were obtained from 30 patients with AAA and 30 with AOD. Aortic histology and immunohistochemistry were performed to evaluate inflammatory changes and MMP and TIMP expression. Thrombosis and ulceration were more frequent in AOD than in AAA. The MMP-9 expression was elevated in all aortic layers of AAA patients and in media/adventitia of AOD patients, mainly followed by lower expression of its inhibitor TIMP-1. Higher MMP-9 expression was also found in SMCs and macrophages of both AAA and AOD specimens, while higher TIMP-1/TIMP-2 were predominantly observed in the lymphocytes and macrophages of the aneurysm. These results showed that both conditions exhibited increased MMP-9 expression; however, the MMP expression pattern differed to some degree between the aneurysms and occlusive disease. The variations in molecular mechanisms underlying dilatative/stenosing disease warrant further investigation.
Topics: Aortic Aneurysm, Abdominal; Aortic Diseases; Arterial Occlusive Diseases; Humans; Immunohistochemistry; Matrix Metalloproteinase 9; Matrix Metalloproteinases; Myocytes, Smooth Muscle; Tissue Inhibitor of Metalloproteinase-1; Tissue Inhibitor of Metalloproteinase-2
PubMed: 29687775
DOI: No ID Found -
Clinical Cases in Mineral and Bone... 2015The history of algodystrophy is controversial and its denomination has changed significantly over time. Silas Weir Mitchell described several cases of causalgia due to... (Review)
Review
The history of algodystrophy is controversial and its denomination has changed significantly over time. Silas Weir Mitchell described several cases of causalgia due to gunshot wounds that occurred during the American Civil War, increasing knowledge about this clinical condition. A later key milestone in the history of CRPS is tied to the name of Paul Sudeck that, using X-ray examinations, described findings of bone atrophy following a traumatic event or infection of the upper limb. The most widely accepted pathogenic hypothesis, proposed by Rene Leriche, supported a key role of the sympathetic nervous system in the onset of the typical clinical picture of the disease, which was thus defined as "reflex sympathetic dystrophy". In the 50s John J. Bonica proposed a staging of CRPS. In a consensus conference held in Budapest in 2003, it was proposed a new classification system that included the presence of at least two clinical signs included in the four categories and at least three symptoms in its four categories. There have been other classification systems proposed for the diagnosis of CRPS, such as Veldman diagnostic criteria based on the presence of at least 4 signs and symptoms of the disease associated with a worsening of the same following the use of the limb and their location in the same area distal to the one that suffered the injury. On the other hand, the Atkins diagnostic criteria are much more objective than those proposed by IASP and are specifically applicable to an orthopaedic context. However, current classification systems and related criteria proposed to make a diagnosis of CRPS, do not include instrumental evaluations and imaging, but rely solely on clinical findings. This approach does not allow an optimal disease staging especially in orthopaedics.
PubMed: 27134625
DOI: 10.11138/ccmbm/2015.12.3s.004 -
Surgical Case Reports Apr 2022A 78-year-old male presented with a positive fecal occult blood test. Rectal cancer was detected during lower gastrointestinal endoscopy, and further investigations led...
A 78-year-old male presented with a positive fecal occult blood test. Rectal cancer was detected during lower gastrointestinal endoscopy, and further investigations led to a diagnosis of cT1N0M0 cStage I (UICC classification, 8th edition). Preoperative contrast-enhanced computed tomography (CT) showed that the patient also had Leriche syndrome, which is associated with reduced blood flow to the rectum that may result in ischemic anastomosis during rectal cancer surgery with anastomotic reconstruction. The inferior epigastric arteries often function as collateral pathways to the lower limbs in patients with Leriche syndrome; therefore, care is needed to avoid vascular damage during trocar insertion when performing laparoscopic surgeries. We herein described a case of safe laparoscopic low anterior resection in a rectal cancer patient with Leriche syndrome using vascular architecture images obtained by preoperative CT angiography.
PubMed: 35476162
DOI: 10.1186/s40792-022-01438-1