Leriche syndrome is a blockage of the main artery (aorta) in the lower extremity.
The blockage of blood vessels in the aorta occurs between the exit of the renal arteries and their branching (bifurcation) into the pelvic arteries.
The result is reduced blood flow to the legs and genital area, which can lead to symptoms such as pale skin in the legs, pain, paralysis, or erectile dysfunction.
In professional circles, Leriche syndrome is also called infrarenal aortic occlusion.
It is usually a chronic condition that develops gradually.
So-called collateral vessels develop, which bypass the blocked segment and thus allow less blood flow.
Possible causes of Leriche syndrome
Leriche syndrome is a reduction in blood flow due to a blockage of the blood vessels in the aorta.
The aorta is the main artery that starts from the heart and from which the larger arteries branch off.
A blockage of the lower aorta in Leriche syndrome can result from atherosclerosis.
Atherosclerosis is a disease of the arteries in which plaque gradually builds up and narrows the cross-section of the blood vessels.
Atherosclerosis, in turn, is caused by several factors such as smoking, high blood pressure, being overweight, high blood lipids, lack of physical activity, or diabetes (type 2 diabetes).
Symptoms of Leriche syndrome
Leriche syndrome causes discomfort in the lower parts of the body.
The pain can occur in the legs (mainly thighs), buttocks, as well as hips.
The legs are often pale in color and cold, and the pulse on the thighs and in the groin is weak or absent.
The patient may feel numbness and weakness in the legs, or sometimes paralysis.
The walking distance that the affected person can travel without pain is also reduced.
This is appropriately referred to as intermittent walking: sufferers keep stopping to look like they’re checking store windows, but this actually allows their legs to rest. The medical term for it is intermittent claudication.
Wound healing disorders in the legs can also become highly noticeable.
Dysfunction of the urinary bladder or intestines can also occur in Leriche syndrome.
In men, reduced blood flow may affect the penis and lead to erectile dysfunction.
Another possible cause of Leriche syndrome is a blockage of the aorta in the lower region due to a blood clot (embolism or thrombus).
Furthermore, inflammation of the blood vessels can also lead to Leriche syndrome.
Diagnosis of lower extremity aortic occlusion in Turkey
The doctor conducts a screening interview with the patient (patient history). He finds out the symptoms as well as possible previous illnesses. The patient is physically examined, and the doctor, in particular, assesses the condition of the legs and some other parts of the body.
Leriche syndrome is detected using imaging techniques. Ultrasound. “Doppler echocardiography is an ultrasound scan that can be used to accurately determine blood flow in blood vessels.
DSA (also called digital subtraction angiography) is particularly suitable as a method in which only the inside of the blood vessels is visualized.
Magnetic resonance angiography (MRA) is another well-suited method and a very sophisticated imaging modality. However, it is expensive.
Differential diagnosis
Many vascular conditions can mimic the symptoms of Leriche syndrome and should be considered in the differential diagnosis.
Arterial dissection, particularly in the iliac arteries, may cause claudication and absence of femoral pulses that mimic the symptoms of Leriche syndrome.
The presence of resting pain and the specific time course of symptom onset may be helpful in identifying underlying pathology in conjunction with ultrasonography and arteriography.
Many vascular patients are at increased risk for acute dissection and occlusion.
Critical limb ischemia is not often seen in Leriche syndrome, as its time course allows for the development of collateral vessels.
Signs of critical limb ischemia include
Sudden onset of pain in the affected limb, paresthesia, pallor or coldness, and diminished or absent pulses.
The blockage may result from a blood clot, embolism from a nearby vascular area, or dissection.
Leriche syndrome treatment in Turkey
To treat Leriche syndrome, surgery is required to remove the aortic obstruction.
As a rule, a special vascular prosthesis known as a Y-shaped prosthesis or bifurcated prosthesis (also: femoral arterial bypass or iliac bypass) is used.
The vascular prosthesis has an inverted Y shape, in which the lower part of the aorta and the upper parts of the inguinal arteries are blocked.
The material used to replace the blood vessel is made of flexible plastic.
This graft is sewn between the aorta and the inguinal arteries so that there is a vascular connection.
This procedure is done through an incision in the abdomen under general anesthesia.
In very rare cases, a bypass must be created between the artery below the collarbone and the inguinal arteries (bifemoral axillary bypass). This long bypass can be indicated in case of severe atherosclerotic changes in the affected area.
Leriche syndrome, caused by a blood clot (thrombus) that has developed there, can sometimes be treated by scraping the inner blood vessel wall. The procedure is called endarterectomy or thrombectomy.
If the blockage is caused by a blood clot (embolus) that has migrated into the area, an attempt can be made to remove it (embolectomy).
This can be done by direct opening with a catheter (Fogarty catheter) with which the blood clot can be pulled out.
Under certain circumstances, treatment can also be performed using a conventional angioplasty catheter in a procedure called angioplasty (PTA), in which the narrowing of the vessel is expanded by a balloon that is inserted into the vessel through the catheter and then inflated. In addition, a so-called stent, a wire mesh that keeps the vessel open from the inside, can be used.
Complications are possible with these operations. For example, bleeding and infections cannot be ruled out. After blood flow is restored, post-ischemic syndrome can occur – water retention (edema) and the spread of harmful substances from the part that was once again supplied with blood can occur.
The doctor will weigh the reasons for the procedure against the risks; usually, the procedure is justified.
Anticoagulants are generally given as a drug treatment.
Possible complications
The prognosis and the chances of success of the operation depend on many factors. In general, it can be said that the prognosis is usually favorable, because the chronic course means that an intervention with the right preparation is possible and usually does not have to be carried out in an emergency.
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