Leriche syndrome: Clinical and diagnostic approach of a rare infrarenal aortoiliac occlusive disease

Abstract

Leriche syndrome is an aortoiliac occlusive arterial disease comprising decreased peripheral pulses, claudication, and erectile dysfunction. We present a case of a 60-year-old male with abdominal pain and hematochezia who was diagnosed with hemorrhoids. The patient also had associated leg cramps on both sides and lower limb weakness. Further evaluation of the patient with imaging revealed occlusion of the distal descending abdominal aorta below the level of renal arteries and the iliac arteries. An incidental finding of Leriche syndrome was evident. This case report contributes to the current literature when any patient with abdominal pain and bilateral lower limb weakness, Leriche syndrome should be considered to avoid complications as it has high morbidity and mortality.

Keywords: Aorto-occlusive disease; CT angiography; Interventional radiology; Leriche syndrome; Ultrasound Doppler.

Fig. 1

Leriche syndrome: color Doppler showing hypoechoic plaque within the lumen of the distal abdominal aorta with no color flow (yellow arrows).

Fig. 2

Leriche syndrome: color and pulse wave Doppler ultrasound demonstrates turbulent flow and elevated peak systolic velocity within the narrowed segment of abdominal aorta.

Fig. 3

Leriche syndrome: color and pulse wave Doppler ultrasound of abdominal aorta showing “tardus parvus” waveform below the level of renal arteries. The main renal arteries were patent with normal flow velocities.

Fig. 4

Leriche syndrome: Doppler waveform of right external iliac artery demonstrate decreased systolic velocities and increased acceleration time indicating “tardus parvus” waveform suggesting significant proximal obstruction.

Fig. 5

Leriche syndrome: noncontrast CT coronal showing plaque within the distal abdominal aorta and its branches (yellow arrows).

Fig. 6

Leriche syndrome: Contrast enhanced CT showing no contrast opacification of distal abdominal aorta below renal arteries (yellow arrow).

Figure 7

Leriche syndrome: Contrast enhanced CT arterial phase (A) coronal (B) sagittal showing non contrast opacification of the distal abdominal aorta below the renal arteries (yellow arrows).

Figure 8

Leriche syndrome: Contrast enhanced CT arterial phase showing non contrast opacification of right common iliac artery (blue arrow) and partial contrast opacification of left common iliac artery (yellow arrow).

Figure 9

Leriche syndrome: The three dimensional CT rendering technique (VRT) of the abdomen with aortic angiography and lower extremity showing atherocalcific changes of bilateral external iliac arteries (blue arrows) and non-visualization of infrarenal abdominal aorta with establishment of collaterals (yellow arrows).

Figure 10

Leriche syndrome: contrast enhanced CT arterial phase showing normal contrast opacification of superior mesenteric artery without any plaque or thrombosis.