Leriche's syndrome

Overview

Leriche’s syndrome, also known as aortoiliac occlusive disease, is a form of peripheral arterial disease (PAD) characterized by the blockage or narrowing of the abdominal aorta and/or iliac arteries. This condition leads to reduced blood flow to the lower limbs and pelvis, resulting in a combination of symptoms that include leg pain, diminished pulses, and erectile dysfunction in men. Leriche’s syndrome is most commonly seen in middle-aged or older individuals, especially those with a history of atherosclerosis or cardiovascular risk factors.

Causes

The primary cause of Leriche’s syndrome is atherosclerosis, a condition in which fatty deposits (plaques) build up on the inner walls of arteries, leading to reduced or obstructed blood flow. Other contributing factors may include:

• Smoking – a major risk factor for vascular disease

• Hypertension

• Hyperlipidemia – high levels of cholesterol and triglycerides

• Diabetes mellitus

• Advanced age

• Obesity and sedentary lifestyle

Symptoms

Leriche’s syndrome typically presents with a classic triad of symptoms due to impaired blood flow to the lower extremities and pelvic organs:

• Claudication – pain, cramping, or fatigue in the hips, thighs, or buttocks during walking or exercise that improves with rest

• Absent or diminished femoral pulses – weak or non-palpable pulses in the groin or legs

• Erectile dysfunction – due to reduced blood flow to the pelvic region in men

Other symptoms may include cold or pale lower limbs, muscle atrophy, delayed wound healing, or in severe cases, critical limb ischemia with rest pain or ulcers.

Diagnosis

Diagnosis of Leriche’s syndrome involves clinical evaluation, vascular examination, and imaging studies. Key diagnostic tools include:

• Physical examination – including palpation of peripheral pulses and inspection for skin changes

• Ankle-brachial index (ABI) – a non-invasive test comparing blood pressure in the ankle and arm to detect reduced blood flow

• Doppler ultrasound – to assess blood flow and detect arterial narrowing

• CT angiography or MR angiography – to visualize the location and extent of arterial occlusion

• Conventional angiography – may be used before surgical or endovascular intervention

Treatment

Treatment of Leriche’s syndrome focuses on restoring adequate blood flow to the affected areas and managing underlying risk factors. Therapeutic options include:

• Lifestyle modifications – smoking cessation, regular exercise, dietary changes, and weight management

• Medical management – includes antiplatelet agents (e.g., aspirin or clopidogrel), statins, antihypertensives, and medications to improve walking distance (e.g., cilostazol)

• Endovascular therapy – angioplasty with or without stent placement to reopen narrowed arteries

• Surgical treatment – aortobifemoral bypass grafting for severe or extensive occlusion

The choice between endovascular and surgical treatment depends on the extent of the occlusion, patient comorbidities, and overall health status.

Prognosis

The prognosis for individuals with Leriche’s syndrome varies based on the severity of the disease and the timeliness of treatment. With proper management, symptoms can be significantly improved, and the risk of limb loss reduced. However, untreated or advanced cases can lead to critical limb ischemia and increase the risk of cardiovascular events such as heart attack or stroke. Lifelong follow-up and aggressive control of cardiovascular risk factors are essential for improving long-term outcomes and preventing recurrence.