Comprehensive Case Presentation: Leriche Syndrome in a 50-Year-Old Male Smoker
Mr. S, a 50-year-old male smoker, presented with bilateral lower extremity claudication and erectile dysfunction, worsening over four years. He experiences pain on ambulation, especially uphill. Physical examination revealed diminished femoral pulses and an ABI of 0.5 on the right and 0.6 on the left. Imaging studies showed distal aorta occlusion and chronic common iliac artery occlusion indicative of Leriche syndrome. This condition is characterized by the triad of claudication, absent femoral pulses, and erectile dysfunction, often associated with atherosclerosis and risk factors including smoking and hypercholesterolemia.
Comprehensive Case Presentation: Leriche Syndrome in a 50-Year-Old Male Smoker
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Presentation Transcript
Show Your Best Kolapo DaSilva
Case Presentation • CC • Pain when walking • HPI • Mr S. – 50 y.o. male smoker presenting 10/8/08 to vascular clinic for bilateral LE claudication • Pain on ambulation x 1-2 blocks, beginning in buttocks, extending to thighs and calves • Progressively worsening for past 4 years • Worse when walking uphill/stairs • Denies nonhealing foot ulcers • Also complains of erectile dysfunction
Case Presentation • PHM, FH • Non contributory • PSH • Ureteral strictures s/p ?recurrent UTIs • Soc Hx • ½ PPD x 10 years • Denies alcohol use
Case Presentation • PE • Pleasant gentleman in NAD • Wt 59.5 kg, T 36.4 • Neck: Negative carotid bruits. • Chest: Clear to auscultation bilaterally. • Cardiovascular: RRR s gallops, rubs, or murmurs. • Abdomen: soft and mildly protuberant, bowel sounds present. No pulsatile masses. No organomegaly. • Extremities: 2+ equal radial pulses. Nonpalpable femoral pulses bilaterally. Nonpalpable politeal and distal pulses bilaterally. No ischemic or venostasis changes. ABI – 0.5 on right, 0.6 on left • Labs/studies • ABI (7/25/08): 0.5 on right, 0.6 on left • Aorto-Iliac Duplex (11/10/08): distal aorta occlusion distal to origin of renal arteries. Occlusion of the bilateral common iliac arteries.
Case Presentation • Labs/studies (continued) • CTA of the abdomen and pelvis and bilateral lower extremities • Crescenticthrombus within the descending aorta, extending to below the renal arteries, where there is total occlusion • Common iliac arteries are chronically occluded and small • Enlarged inferior epigastric arteries bilaterally which fill the common femoral arteries and external iliac arteries in a retrograde fashion into the internal iliac arteries.
Diagnosis • Leriche Syndrome • Triad of buttock/leg claudication, absent/diminished femoral pulses, and erectile dysfunction • Caused by occlusion of distal abdominal aorta at bifurcation into common iliac arteries by atheroma • Usually affects younger males (30-40s) • Associated with cigarette smoking, hypercholesterolemia, not necessarily diabetes (smaller vessel disease)
Diagnosis – Mr. S’s Risk Factors • Leriche Syndrome • Triad of buttock/leg claudication, absent/diminished femoral pulses, and erectile dysfunction • Caused by occlusion of distal abdominal aorta at bifurcation into common iliac arteries by atheroma • Usually affects younger males (30-40s) • Associated with cigarette smoking, hypercholesterolemia (pt cholesterol 274 on 6/5/06 (nl 125-200), not necessarily diabetes (smaller vessel disease)
Treatments Aortoiliac bypass graft Axillofemoral and femoral-femoral bypass (ax-fem fem-fem)
References • Wikipedia • LearningRadiology.com • UpToDate • Images obtained via Google Images, IDX Image Cast, and LearningRadiology.com
