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Leriche Syndrome

Leriche Syndrome is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Leriche syndrome, also known as aortoiliac occlusive disease, is the constellation of symptoms caused by atherosclerotic stenosis of the abdominal aorta as it bifurcates into the iliac arteries. Patients typically present with chronic complaints such as lower extremity pallor and pain; however, rare but life-threatening events such as acute limb ischemia may also occur. The classic triad of findings first described by French surgeon René Leriche in the 1940s includes diminished femoral pulses; claudication of the thighs, pelvis, and/or buttocks; and erectile dysfunction in male patients.

Epidemiology

Incidence
Unknown; however, the incidence of other forms of atherosclerotic disease such as coronary artery disease (CAD) and peripheral artery disease (PAD) increases with advancing age.

Prevalence
  • Unknown; estimated 5–10% of patients with PAD
  • Unique triad of symptoms (erectile dysfunction in males, diminished pulses, and claudication of thighs) appears in patients between 40 and 60 years, which is younger than general PAD patients (1).
  • Chronic disease appears to be more common in males; when it presents acutely, more likely to be in female patients and is associated with almost 50% mortality

Etiology and Pathophysiology

  • Most common etiology is occlusive plaque in aortoiliac arteries. Like other forms of atherosclerotic disease, main contributing factors include arterial wall damage by hypertension, nicotine, and lipid accumulation—all of which lead to the development of atheromas.
  • Occasionally, nonocclusive atheromas degenerate and embolize to distal portions of the body, resulting in acute limb ischemia or “blue toe” syndrome.
  • Rarely caused by Takayasu disease, which is a granulomatous large-vessel vasculitis
  • Cigarette smoking and hypercholesterolemia are the most common risk factors.
  • Less likely to be associated with diabetes than typical patterns of PAD

Genetics
Family history of hypercholesterolemia and PAD

Risk Factors

  • Tobacco use
  • Male gender (1)
  • Hypertension
  • Diabetes mellitus
  • Homocysteinemia
  • Black race
  • Hypercholesterolemia
  • Family history of PAD

General Prevention

  • Role of fat in diet is complex.
  • Exercise
  • Blood pressure control
  • Smoking cessation

Commonly Associated Conditions

  • Hypertension
  • CAD
  • Myocardial infarction (MI)
  • Stroke
  • PAD

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Citation

Stephens, Mark B., et al., editors. "Leriche Syndrome." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816303/0/Leriche_Syndrome.
Leriche Syndrome. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816303/0/Leriche_Syndrome. Accessed July 19, 2019.
Leriche Syndrome. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816303/0/Leriche_Syndrome
Leriche Syndrome [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 July 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816303/0/Leriche_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Leriche Syndrome ID - 816303 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816303/0/Leriche_Syndrome PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -