From the Guidelines
Leriche syndrome, also known as Aortoiliac Occlusive Disease, is a vascular condition characterized by the blockage of the aorta where it divides into the iliac arteries in the lower abdomen, typically caused by atherosclerosis, leading to a classic triad of symptoms including claudication, impotence, and decreased or absent femoral pulses. This condition is defined under the anatomic level as "Aortoiliac—Includes infrarenal abdominal aorta, common iliac, and external and internal iliac arteries" 1. The syndrome primarily affects men in their 40s to 60s and may also cause muscle atrophy, hair loss on the legs, and cool, pale skin in the lower extremities.
Key Characteristics
- Claudication (pain) in the buttocks, thighs, and calves during activity
- Impotence in male patients
- Decreased or absent femoral pulses
- Muscle atrophy
- Hair loss on the legs
- Cool, pale skin in the lower extremities Diagnosis typically involves imaging studies such as CT angiography, MRA, or conventional angiography.
Treatment Options
- Surgical intervention: aortobifemoral bypass grafting, aortoiliac endarterectomy
- Endovascular procedures: angioplasty and stenting Without treatment, the condition can lead to serious complications including critical limb ischemia, tissue death, and potentially limb amputation. The underlying cause is typically atherosclerosis, so managing risk factors such as smoking, hypertension, diabetes, and high cholesterol is essential for both prevention and post-treatment care, as outlined 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.
From the Research
Definition and Characteristics of Leriche Syndrome
- Leriche syndrome is a rare disease caused by atherosclerosis, characterized by symptoms such as intermittent claudication, numbness, and coldness of the lower limbs 2.
- It is defined as atherosclerotic occlusion of the infrarenal aorta and/or the iliac axis, associated with claudications or critical limb ischemia and erectile dysfunction in men 3.
- The Leriche syndrome triad includes claudication in the proximal lower extremity, decreased or absent femoral pulses, and, in some cases, impotence 4.
Diagnosis and Treatment
- Diagnosis of Leriche syndrome can be made using computed tomography with angiography of the abdominal aorta, which reveals a Leriche-type occlusion of the infrarenal abdominal aorta and iliac arteries 4.
- Treatment options include aortobifemoral bypass with subsequent anti-aggregation therapy, which has been shown to be effective in patients with Leriche syndrome 3.
- Endovascular treatment, such as recanalization and stent placement, is also a viable option, especially for patients with severe comorbidities 3, 5.
- Early recognition and diagnosis are crucial for optimal outcomes, as delayed treatment can result in mortality 6.
Clinical Presentation and Outcomes
- Patients with Leriche syndrome may present with atypical symptoms, such as foot pain, making early diagnosis challenging 4.
- Collateral vessel formation can make the symptoms of Leriche syndrome vague and inconsistent, often making early recognition difficult 4.
- Successful treatment of Leriche syndrome can result in significant hemodynamic improvement, improved walking capacity, and reduced symptoms of peripheral arterial disease 5.