Aortoiliac Occlusive Disease

Sonographic Discovery of Leriche Syndrome and the Development of Collaterals

“…7 Risk factors include smoking, dyslipidemia, hypertension, diabetes mellitus, male gender, advanced age, and a high genetic risk. 8 Patients usually present with a triad of symptoms which include intermittent claudication of the buttocks and thighs, absent or decreased femoral pulses, and impotence in men. 3 Upon physical examination, an absent or diminished femoral pulse is usually discovered.…”

“…In some patients, pulses could be palpable but disappear with ambulation and the onset of claudication. 8 Other clinical symptoms may occur depending on the severity of the disease, such as limb ischemia and muscle atrophy; however, most patients are relatively asymptomatic because of the development of large, extensive collateral vessels between abdominal, pelvic, and infrainguinal arteries. 9 The development of collateral pathways for arterial blood flow is a hallmark sign of chronic obstruction seen with Leriche syndrome.…”

“…ABIs, segmental pressure measurements, and pulse volume recordings are the 3 most commonly used noninvasive modalities. 8 Leriche syndrome typically presents as an inflow problem, with a decrease in the thigh brachial index and pulse wave amplitude. A difference of at least 20 mm Hg between the brachial pressure and the decreased proximal thigh pressure reflects a significant stenosis in the aorta and/or iliac arteries.…”

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“…[22] The natural history of aortoiliac occlusive disease is slow progression proximally and distally overtime to end in complete occlusion of the aorta and iliac arteries. [27] Considering the above facts, the atherogenesis process in arotoiliac arteries is similar to Urustambha samprapti [ Table 2]. …”

“…An increased tolerance to demand ischemia may be a probable mechanism for such observed improvement. [27] In PAD, a supervised exercise program is recommended for a minimum period of 30-45 min at least 3 times a week for a minimum of 12 weeks. [30] Daily exercise to the point of claudication not only increases the walking tolerance but also enhances collateral circulation.…”