Leriche syndrome, named after French surgeon René Leriche, is a form of aortoiliac occlusive disease. It is caused by thrombotic occlusion of the abdominal aorta just above its bifurcation into the common iliac arteries.

⚙️ Aetiology

🧬 Atherosclerosis: Most common cause → progressive narrowing and thrombotic occlusion.
🔥 Other factors: Vasculitis, inflammatory arteritis, hypercoagulable states.
Compromised blood flow often involves pudendal arteries → explains erectile dysfunction 🍆.

🩺 Clinical Presentation

🚶‍♂️ Claudication: Fatigue + crampy pain in buttocks & thighs, bilateral.
🍑 Buttock ischemic pain: Worsens with exertion.
🍆 Erectile dysfunction: Due to pelvic hypoperfusion (part of classic triad).
✋ Pulses: Absent/diminished femoral pulses on exam.

💡 Clinical Pearl: The classic triad of Leriche syndrome is: 🚶‍♂️ Claudication of buttocks/thighs + 🍆 Erectile impotence + ✋ Absent femoral pulses.

🔍 Differential Diagnosis

🌱 Buerger’s disease (thromboangiitis obliterans)
🔥 Arteritis (Takayasu, giant cell arteritis)
🦵 Peripheral arterial disease of other levels

🧪 Investigations

🧾 Bloods: FBC, U&E, glucose/HbA1c, ESR, lipid profile, ECG → screen vascular risk factors.
🖼️ Imaging: CTA or MRA to delineate extent of occlusion. Angiography if intervention planned.

🛠️ Management

💊 Medical: Antiplatelets, statins, BP & diabetes control, smoking cessation 🚭.
🩻 Endovascular: Angioplasty ± stenting for focal disease or high-risk surgical patients.
🔪 Surgical:
- Aortoiliac Endarterectomy: Remove plaque directly.
- Aortobifemoral bypass (AFB): Graft restoring flow from aorta → femorals.

📚 Case Example

👨 A 58-year-old man, heavy smoker, presents with progressive thigh claudication 🚶‍♂️, buttock pain 🍑, and erectile dysfunction 🍆. Exam: Absent femoral pulses ✋, but distal pulses weakly palpable. CTA shows aortoiliac occlusion just above bifurcation. ✅ Diagnosis: Leriche syndrome. 🛠️ Management: Start aspirin + statin, smoking cessation; referred for vascular surgery → aortobifemoral bypass considered.

🔎 Conclusion

Leriche syndrome is a severe form of aortoiliac occlusive disease. The hallmark triad = 🚶‍♂️ bilateral claudication, 🍆 erectile dysfunction, and ✋ absent femoral pulses. Management ranges from risk-factor optimisation 💊 to endovascular therapy 🩻 or definitive surgery 🔪, tailored to disease extent and patient comorbidity.

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Leriche syndrome (aortoiliac occlusive disease)

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