Lerch syndrome is a blockage of the main artery (aorta) in the lower extremity region.
The aortic occlusion is located between the outlet of the renal arteries and their branching (branching) in 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, Lerich syndrome is also called subrenal aortic obstruction.
It is usually a chronic condition that develops gradually.
Where the so-called collateral vessels develop, which bypass the closed part and thus allow less blood flow.
Possible causes of Lerich syndrome
Lerch syndrome is a decrease in blood flow caused by a blockage in a blood vessel in the aorta.
The aorta is the main artery that starts from the heart and from which the great arteries branch.
An obstruction of the lower aorta can result from atherosclerosis.
Atherosclerosis is a disease of the arteries in which plaque builds up gradually and narrows the cross-section of the blood vessels.
Atherosclerosis, in turn, is caused by several factors such as: smoking, high blood pressure, excessive weight, high blood lipids, in addition to lack of physical activity or diabetes (type 2 diabetes).
Symptoms of Lerch Syndrome (Lower Aortic Occlusion)
Lerch syndrome causes discomfort in the lower parts of the body.
The pain can occur in the legs (mainly the thighs), buttocks, as well as the hips.
The legs are often pale and cold.
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 walk without pain is also reduced.
This is also aptly referred to as intermittent walking: sufferers continue to stop to appear to be looking out of shop windows, but this actually allows their legs to relax. The medical term for it is Intermittent claudication.
Wound healing disorders in the legs can also become more noticeable.
An abnormality of the urinary bladder or intestines can also occur in Lerich syndrome.
In men, reduced blood flow can affect the penis and erectile dysfunction can occur.
Another possible cause of Lerich syndrome is a blockage of the aorta in the lower region due to a blood clot (occlusion or thrombus).
Moreover, inflammation of the blood vessels can lead to Lerich's syndrome.
Diagnosis of aortic obstruction in the lower region in Turkey
The doctor conducts a screening interview with the patient (history). It detects symptoms as well as possible past illnesses. The patient is physically examined and the doctor in particular assesses the condition of the legs and some other parts of the body.
Lerch syndrome is detected using imaging techniques. Ultrasound. Doppler echocardiography is an ultrasound examination that can be used to accurately determine blood flow in a blood vessel.
It is also possible to diagnose by digital subtraction angiography DSA (also called digital subtraction angiography) is particularly suitable as a method in which only the inside of the blood vessel is viewed.
Magnetic resonance angiography (MRA) is another well-suited method and is a very sophisticated imaging method, but it has the disadvantage of its high cost.
differential diagnosis
Many vascular conditions can mimic the symptoms of Lerich syndrome and should be considered in the differential diagnosis.
Arterial dissection, particularly of the iliac arteries, may cause claudication and absence of femoral pulses that mimic the symptoms of Lerich's syndrome.
The presence of rest pain and the specific time course of symptom onset may be useful in identifying underlying disease in conjunction with ultrasound and arteriography.
There are many vascular patients at increased risk of dissection and acute occlusion.
Critical limb ischemia is not often seen in Lerrich's syndrome, as its temporal course allows for the development of collateral vasculature.
Signs of critical limb ischemia include:
Sudden onset of pain in the affected limb, numbness, paleness or coldness, and diminished or absent heartbeats.
The blockage may result from a blood clot, emboli from the area of a nearby blood vessel, or a dissection.
Lerich syndrome treatment in Turkey
To treat Lerich syndrome, surgery to remove the aortic blockage is needed.
As a general rule, a special prosthesis known as a Y-shaped prosthesis or bifurcated prosthesis (also: arteriofemoral bypass or iliac bypass) is used.
The 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 vessels is made of flexible plastic.
This graft is sutured between the aorta and the inguinal arteries so that there is a vascular connection.
This operation is done through an incision in the abdomen under general anaesthesia.
In very rare cases, a lateral bypass must be created between the artery below the collarbone and the inguinal arteries (bilateral axillary-femoral bypass). This long bypass may be indicated if severe changes in atherosclerosis occur in the affected area.
Lerich's syndrome caused by a blood clot (thrombus) that has formed there can sometimes be treated by scraping the inner blood vessel wall. The operation for this procedure is called an endarterectomy or thromboembolic endarterectomy.
If the blockage is caused by a blood clot (embolus) that has migrated to the area, it may be attempted to remove it (emboli excision).
This can be done by direct opening by thecatheter (Fogarty catheter) through which a blood clot can be withdrawn.
Under certain circumstances, treatment with a conventional angioplasty can also be done in a procedure called angioplasty (PTA), in which a narrowed blood vessel is widened by a balloon inserted into the blood vessel through the catheter and then inflated. In addition, a so-called brace can be used, which is a wire mesh that keeps the bowl open from the inside.
Complications are possible with these operations. For example, bleeding and infections cannot be excluded. After the blood supply is restored, post-ischemic syndrome can occur - water retention (edema) and the diffusion of harmful substances from the part to which the blood was supplied with blood is possible again.
The doctor will weigh the reasons for the procedure against the risks; The action is usually justified.
Anticoagulants are generally given as drug therapy.
Possible complications
The prognosis and chances of successful operation depend on many factors. In general, it can be said that the outlook is usually favorable, since the chronic course means that intervention with proper preparation is possible and usually does not have to be carried out in an emergency situation.