Leriche Syndrome

Liao, Steve; Luthra, Munish; Rogers, Kevin M.

doi:10.1016/j.jacc.2009.06.037

Cited by 7 publications

(7 citation statements)

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“…AIOD might have different presentations in patients ranging from erectile dysfunction and paraplegia to sudden multisystem vasoocclusive catastrophe [10][11][12][13]. The sudden onset paraparesis with diffuse atherosclerotic involvement of coronary and splanchnic circulation due to long segment thrombus occluding aorta complicated management in this case.…”

Section: Discussionmentioning

confidence: 99%

Leriche Syndrome: Acute Onset Painful Paraplegia of Vascular Origin with Catastrophic Consequences

Mahendrakar¹

2017

JCDR

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A 59-year-old male patient was admitted to Emergency Room with acute onset of lower backache, bilateral lower limb weakness, intense pain, and paraesthesia with inability to walk for preceding six hours with no history of trauma. He was a reformed smoker with a sedentary life style as a carom player and had dyslipidaemia but was not on any medications. After initial evaluation a Magnetic Resonance Imaging (MRI) of the lumbosacral spine was done which showed no evidence of compressive myelopathy. Shortly afterwards he developed dyspnoea and excruciating bilateral lower limb pain for which he was transferred to our Intensive Care Unit (ICU) for further management. Careful prodding revealed that patient had an unevaluated bilateral intermittent lower limb pain on exertion since last six months. On clinical examination patient had body mass index of 27.68 kg/m 2 . Heart Rate (HR) of 140/minute, non invasive blood pressure of 150/90 mmHg with absent bilateral femoral and distal lower limb pulsations while other pulsations were normal. Patient had a Respiratory Rate (RR) of 34/minute with orthopnoea, bilateral basal crepitations and 95% Oxygen Saturation (SpO 2 ) on four litres oxygen by facemask. Both the lower limbs were cold with motor power of 0/5 at bilateral hip joints and distally with absent deep tendon reflexes but a detailed neurological exam could not be performed. Electrocardiogram showed sinus tachycardia with ST segment depression in inferolateral leads. Bedside two-dimensional echocardiogram showed global hypokinesia with left ventricular ejection fraction of 25% with a normal sized right atria and right ventricle. Routine blood investigations showed mild leucocytosis with a normal haemoglobin, renal and liver function tests. Cardiac biomarkers Creatine Kinase (CK-MB): 29.2 ng/ml. Troponin-I: 1.2 ng/ml, Brain Natriuretic Peptide (BNP): 1230 pg/ml and D-Dimer: 3590 ng/ml were elevated. He was stabilized with non invasive ventilation, antiplatelets, statins, loop diuretics, Low Molecular Weight Heparin (LMWH) and intravenous nitroglycerine. An urgent CT aortogram was done which showed complete occlusion of infra renal aorta, proximal segment of both common iliac arteries and origin of internal mesenteric artery with partial thrombosis of mid-distal segment of both common iliac, external iliac, internal iliac and both common femoral arteries along with bilateral wedge renal and splenic infarct [Table/ Fig-1,2].In view of acute onset atherosclerotic long segment thrombus, surgical intervention was planned. The patient underwent emergency bilateral trans-femoral embolectomy and about 20 cm long thrombus with diffuse atherosclerosis was removed [Table/ Fig-3]. Postoperatively patient was shifted back to ICU and examination showed warm and re-perfused bilateral lower limbs with definite distal pulses but persistent motor and sensory loss. Antiplatelets and LMWH were continued along with Inj. piperacillintazobactum 4.5 gm intravenously in thrice daily dosing. Adequate hydration, urine output was maintained post...

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Section: Discussionmentioning

confidence: 99%

Leriche Syndrome: Acute Onset Painful Paraplegia of Vascular Origin with Catastrophic Consequences

Mahendrakar¹

2017

JCDR

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“…Todo lo anterior hace importante traer este caso a colación y es pertinente recalcar el valor del examen físico vascular periférico, asociado con el conocimiento y alta sospecha clínica de obstrucción vascular aórtica, en aquellos paciente que asisten a consulta de urgencias con cuadro de deterioro neurológico medular agudo, porque gran porcentaje de ellos tienen una etiología de origen vascular y el tiempo de demora en el diagnóstico y tratamiento influye inversamente proporcional en el pronóstico de los pacientes 1,2,19,20 .…”

Section: Discussionunclassified

Caso clínico de interés: síndrome de Leriche

Chaves

Pineda²,

Imbachi³

2016

rcslibre

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El síndrome de Leriche es una afección causada por obstrucción de la aorta terminal, las ramas principales de la aorta abdominal, como en la obstrucción aortoilíaca. El síndrome de Leriche suele darse en varones y está caracterizado por impotencia, ausencia de pulso en las arterias femorales, debilidad y entumecimiento en región lumbar, nalgas, caderas y extremidades inferiores. En muchas ocasiones esta entidad es poco conocida en el ámbito de América Latina; algunos casos reportados en países como Bolivia, Brasil, Argentina, Chile, México entre otros, describen características propias de experiencias en casos de pacientes en algunas instituciones de estos países. Se quiere dar a conocer un caso encontrado en el Hospital San José de Popayán en el área de urgencias y generar la importancia de realizar un enfoque terapéutico adecuado ante entidades con compromiso vascular extenso porque producen un pronóstico catastrófico si no se realiza atención oportuna, diagnóstico precoz y tratamiento temprano. Palabras clave: Enfermedad arterial oclusiva, Obstrucción aorta, Obstrucción de aorta abominal,Síndrome de Leriche. AbstractThe Leriche syndrome is a condition caused by occlusion of terminal aorta, the primary branches of the abdominal aorta, as in aortoiliac obstruction. Leriche syndrome usually occurs in males and is characterized by impotence, absence of a pulse in the femoral arteries, weaknesses and numbness in the lower back, buttocks, hips, and lower limbs. Is more situations disease little known in Latin American, some cases is reported in Bolivia, Brazil, Argentina, Chile, Mexican countries and others, so we want to present a case in Hospital San José, Popayán, Colombia in emergency area and show the importance of suitable clinical examination about vascular disease for early diagnosis and appropriate treatment.

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“…13 A monophasic waveform with no reverse diastiolic flow, combined with a PSV of <45 cm/s in the CFA, is highly predictive of iliac occlusion. 13,14 Compared with the normal triphasic waveform, a monophasic waveform indicates severe proximal obstruction and low resistance of the distal vascularity resulting from vasodilation and possible inflammation in response to the ischemic change. 13 When there is presence of visceral collateral circulation, the upstroke of the systolic portion of the spectral waveform is not as rapid because of the relatively slow flow in the collateral arteries.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Discovery of Leriche Syndrome and the Development of Collaterals

Barry

2014

Journal of Diagnostic Medical Sonography

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Leriche syndrome, also referred to as aortoiliac occlusive disease, is complete occlusion of the infrarenal aorta and bilateral common iliac arteries. The development of collateral pathways allows reconstitution of arterial blood flow to the lower extremities, preventing limb ischemia. Patients typically present with a triad of symptoms, which include intermittent claudication of the buttocks and thighs, decreased or absent femoral pulses, and impotence in men. Sonography may play a significant role in diagnosing Leriche syndrome, particularly in cases with contraindications to other more invasive tests. Knowledge of the presentation of aortoiliac occlusion along with recognition of developing collateral pathways assists with the diagnosis and management of this disease.

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Leriche Syndrome

Cited by 7 publications

References 0 publications

Leriche Syndrome: Acute Onset Painful Paraplegia of Vascular Origin with Catastrophic Consequences

Leriche Syndrome: Acute Onset Painful Paraplegia of Vascular Origin with Catastrophic Consequences

Caso clínico de interés: síndrome de Leriche

Sonographic Discovery of Leriche Syndrome and the Development of Collaterals

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