Curriculum · Cardiovascular and Hypertension
Leriche syndrome (aorto-iliac occlusive disease)
What it is
Chronic limb ischemia is the inability of arterial supply to meet the cellular metabolic demand. Leriche syndrome is chronic aortoiliac occlusive disease, and it presents with a triad of:
- Claudication of the buttocks and thighs
- Decreased femoral pulses
- Impotence
The level of the block tells you where the pain will be and which pulses are gone. Aorto-iliac obstruction gives claudication in both buttocks, thighs and calf, absent femoral, popliteal and DP pulses, and impotence. Iliac or common femoral disease gives unilateral claudication in thigh and calf with unilateral absence of femoral and distal pulses. Superficial femoral or popliteal disease gives unilateral claudication in the calf with absent distal pulses. Distal obstruction of the tibial and peroneal vessels gives absent ankle pulses with claudication in calf and foot.
Causes and risk
The causes of chronic limb ischemia are atherosclerosis, vasculitis and artery entrapment. Risk factors split into major and minor:
- Major: smoking and DM
- Minor: HTN, dyslipidemia, obesity, sedentary lifestyle, and past medical history and family history of CAD or CVD
The same disease is not only in the legs, so look for the other manifestations of atherosclerosis: CVD, CAD, impotence, and splanchnic (mesenteric) ischemia.