From the Guidelines
Leriche syndrome should be treated with aortobifemoral bypass grafting as the primary approach, given its high 5-year patency rate of 87.5% and low operative mortality of 3.3% 1. This vascular condition is characterized by the triad of claudication in the buttocks and thighs, impotence, and decreased or absent femoral pulses due to aortoiliac occlusive disease. The syndrome typically affects middle-aged men with atherosclerotic disease, though it can occasionally occur in younger patients with thrombophilia or other vascular disorders. Key considerations in managing Leriche syndrome include:
- Surgical revascularization to restore blood flow to the lower extremities
- Endovascular procedures like angioplasty with stenting for less extensive disease
- Medical management with aggressive cardiovascular risk factor modification, including:
- Antiplatelet therapy (aspirin 81-325mg daily)
- Statins (such as atorvastatin 40-80mg daily)
- Smoking cessation
- Blood pressure control
- Diabetes management if applicable
- Evaluation for erectile dysfunction treatment, which may include phosphodiesterase-5 inhibitors if not contraindicated The condition results from progressive atherosclerotic plaque formation at the aortic bifurcation that gradually reduces blood flow to the lower extremities and pelvic organs, explaining the characteristic symptoms. Early diagnosis is crucial as the condition can progress to critical limb ischemia if left untreated, as noted in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. In some cases, alternative procedures such as iliac endarterectomy, patch angioplasty, or aortoiliac or iliofemoral bypass may be considered, as outlined in the ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease 1. However, aortobifemoral bypass grafting remains the most effective surgical procedure for the treatment of Leriche syndrome, with excellent long-term patency rates and low morbidity 1.
From the Research
Definition and Symptoms of Leriche Syndrome
- Leriche syndrome is an aortoiliac occlusive arterial disease characterized by decreased peripheral pulses, claudication, and erectile dysfunction 2.
- The syndrome is caused by atherosclerosis, affecting the distal abdominal aorta and iliac arteries, and potentially extending to the femoropopliteal vessels 3.
- Symptoms include bilateral intermittent claudication, ischemic pain, and absence of femoral pulses, although some patients may remain asymptomatic due to the development of collateral networks 3.
Diagnostic Approach
- Diagnostic imaging, such as computed tomography angiography, is crucial for early detection and management of Leriche syndrome 3.
- Imaging techniques allow for the identification of the extent of occlusion, assessment of collateral circulation, and evaluation of distal patency, thus guiding surgical intervention 3.
- A case report highlights the importance of considering Leriche syndrome in patients with abdominal pain and bilateral lower limb weakness to avoid complications 2.
Treatment Options
- Endovascular therapy is a feasible and safe treatment option for Leriche syndrome, with excellent mid-term clinical outcomes 4.
- A case report describes the successful use of endovascular therapy for aortoiliac occlusive disease, followed by minimally invasive coronary artery bypass grafting for ischemic heart disease 5.
- Open revascularization using a Dacron aorto-biiliac bypass graft is also a treatment option, although it may be associated with risks such as infection in intravenous drug abusers 6.
- Alternative strategies, such as aortoiliac endarterectomy, total endovascular approach using non-covered stents, or a hybrid approach, may be considered in certain cases 6.