Aortoiliac occlusive disease

Aortoiliac occlusive disease
Plate from Gray's Anatomy showing the abdominal aorta and the common iliac arteries.
Classification and external resources
ICD-9-CM	444.0
DiseasesDB	29335
eMedicine	med/2759
MeSH	D007925

Leriche's syndrome (X-ray)

In medicine, aortoiliac occlusive disease, also known as Leriche's syndrome and Leriche syndrome, is a form of peripheral artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries.

Signs and symptoms

Classically, it is described in male patients as a triad of the following signs and symptoms:

claudication of the buttocks and thighs
absent or decreased femoral pulses
erectile dysfunction

This combination is known as Leriche syndrome.^[1] However, any number of symptoms may present, depending on the distribution and severity of the disease, such as muscle atrophy, slow wound healing in the legs, and critical limb ischemia.

Treatment

Treatment involves revascularization typically using either angioplasty or a type of vascular bypass

Kissing balloon angioplasty +/- stent, so named because the two common iliac stents touch each other in the distal aorta.
Aorto-iliac bypass graft
Axillary-bi-femoral^[2]^[3] and femoral-femoral bypass (sometimes abbreviated "ax-fem fem-fem")

History

The condition was first described by Robert Graham in 1914,^[4]^[5] but the condition with its triad of symptoms was ascribed to René Leriche.^[6] Leriche, a French surgeon, linked the pathophysiology with the anatomy of the condition. John Hunter's dissections of atherosclerotic aortic bifurcations from the late 18th century are preserved at the Hunterian Museum, but Leriche was first to publish on the subject based on a patient he treated with the condition at the age of 30. Following treatment the 30-year-old was able to walk without pain and maintain an erection.^[7]

References

↑
↑ Lee BY, Guerra J (1994). "Axillofemoral bypass graft in a spinal cord injured patient with impending gangrene". The Journal of the American Paraplegia Society. 17 (4): 171–6. PMID 7869060.
↑ McKinsey JF (1995). "Extra-anatomic reconstruction". Surg. Clin. North Am. 75 (4): 731–40. PMID 7638717.
↑ Graham, Robert (1814). "Case of Obstructed Aorta". Med. Chir. Tr. 5: 297.
↑ JAWOR, WJ; PLICE, SG (10 May 1952). "Thrombotic obliteration of the abdominal aorta; report of a case.". Journal of the American Medical Association. 149 (2): 142–3. doi:10.1001/jama.1952.72930190007009b. PMID 14917575.
↑ synd/2747 at Who Named It?
↑ Leriche, R; Morel, A (February 1948). "The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation.". Annals of Surgery. 127 (2): 193–206. doi:10.1097/00000658-194802000-00001. PMID 17859070.

External links

Aortoiliac occlusive disease vascularweb.org
Leriche's syndrome - whonamedit.com
Coronal CT of Leriche' syndrome - learningradiology.com

Cardiovascular disease (vessels) (I70–I99, 440–456)

Arteries, arterioles
and capillaries

Inflammation

Peripheral artery disease

Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Intermittent claudication Critical limb ischemia Monckeberg's arteriosclerosis Arteriolosclerosis Hyaline Hyperplastic Cholesterol LDL Oxycholesterol Trans fat

Stenosis	Carotid artery stenosis Renal artery stenosis

Other	Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon

Aneurysm / dissection /
pseudoaneurysm

Vascular malformation

Vascular nevus

Veins

Inflammation	Phlebitis

Venous thrombosis / Thrombophlebitis	primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease head Cerebral venous sinus thrombosis Post-thrombotic syndrome

Varicose veins	Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele

Other	Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer

Arteries or veins

Blood pressure

Hypertension	Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension

Hypotension	Orthostatic hypotension

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