Leriche syndrome
Leriche syndrome is a special form from the spectrum of peripheral arterial occlusive diseases (PAD). As part of the disease, there is a life-threatening acute or slowly progressive occlusion of the abdominal aorta.
What is Leriche syndrome?
Leriche syndrome is a vascular disease associated with the complete occlusion of the abdominal aorta (occlusion of the abdominal aorta). As a rule, the aortic occlusion develops below the renal artery outlet and above the aortic bifurcation (division of the aorta into the leg arteries).
In general, a distinction is made between an acute and chronic form of disease. The acute variant manifests itself suddenly and should be operated immediately as a life-threatening complication by emergency vascular surgery. Chronic Leriche syndrome, on the other hand, develops gradually as a result of degenerative vascular wall changes.
Causes
In the majority of cases, the aortic occlusion develops progressively due to atherosclerotic changes (chronic Leriche syndrome). Lime and fat deposits as well as connective tissue changes lead to degenerative changes in the vessel wall, which in turn cause an increasing narrowing of the vascular volume. In addition, so-called collateral vessels (bypass circuits) often form to compensate for the reduced oxygen supply, which can delay the onset of symptoms.
In rare cases, Leriche syndrome can be attributed to vasculitides (inflammation of the vessels). Promoting factors are in particular strong nicotine abuse as well as stress, obesity and high blood pressure. In addition, aortic occlusion may occur suddenly as a result of an embolism from the heart (loosened thrombus). Those affected by cardiac arrhythmia (absolute arrhythmia) as well as wearers of pacemakers and artificial heart valves have an increased risk.
Symptoms and course
Typical symptoms of Leriche syndrome:
The symptom picture depends on the specific form of the disease. The acute variant is life-threatening mainly because the organism could not develop collateral vessels due to the sudden occlusion. The pronounced occlusion symptoms of the lower extremity are shown by the mostly dark purple skin coloration (oxygen deficiency discoloration), which can extend to the navel. The oxygen deficiency (ischemia) of both legs leads to increased cardiac work with a greatly increased risk of decompensation (derailment).
In some cases, sensory disturbances and paralysis in the lower limb can also be observed. If left untreated, most of those affected die as a result of circulatory shock. In contrast to the acute situation, the arteriosclerotic occlusion of chronic Leriche syndrome develops slowly. The organism can form collateral vessels to compensate for the lack of oxygen and nutrients. In addition, the symptom picture is very variable.
Often, a moderately pronounced intermittent claudication (intermittent claudication or temporary limping) can be observed. Here, the pain-free walking distance can vary between a few meters and a few kilometers. The localization of pain depends on the exact location of the occlusion. Some sufferers are completely asymptomatic. Since the internal pelvic arteries supplying the blood vessels of the small pelvis are also affected, erectile dysfunction can also occur as part of Leriche syndrome.
Diagnosis
An initial suspicion usually results from the characteristic indicators such as rapid fatigue of the legs, pain, reduced or canceled inguinal pulse as well as erectile dysfunction and the typical skin discoloration. Acute Leriche syndrome is diagnosed on the basis of the 6 P-symptoms (pain pain, pulselessness pulse loss, pallor pallor, paresthesia sensory disturbance, paralysis paralysis, prostrration circulatory shock). Within the framework of imaging procedures such as color-coded duplex sonography or contrast-assisted MR angiography, the changes in the vessels can be visualized and the diagnosis confirmed accordingly.
Complications
Leriche syndrome can cause a number of ailments, such as pain in the buttocks and legs and sensory disturbances. Severe complications are to be expected, among other things, by erectile dysfunction, paralysis and circulatory disorders. As a result of impaired blood circulation, it can lead to pronounced muscle weakness, tissue damage and finally circulatory shock. Erectile impotence mainly causes psychological problems and can also manifest itself in psychosomatic complaints.
Paralysis severely limits mobility and thus quality of life. Mental suffering is the result, especially in the case of longer-lasting or recurring signs of paralysis. Bladder and bowel functions are often also impaired in Leriche syndrome. Those affected then suffer from incontinence, urinary retention and other complaints. As a result of the spinal ischemia that typically occurs, neurological complications can also occur.
As part of the treatment, a bypass often has to be placed, which is associated with the risk of bleeding, cardiac arrhythmia and infection of the surgical wound. Kidney failure and heart attacks are also possible but rare consequences of such a procedure. The accompanying painkillers and anti-inflammatory drugs can cause side effects and interactions and occasionally trigger an allergic reaction.
treatment and therapy
Both variants of Leriche syndrome are usually treated with vascular surgery. In an acute situation, the clot that caused the occlusion can be removed via the bilaterally opened inguinal artery as part of an emergency embolectomy using a so-called Fogarty catheter (embolectomy catheter). As a result, the surgical intervention can be kept as small as possible and the prognosis of the affected person can be improved.
If this procedure is not medically indicated, a bypass from the healthy aortic area below the renal artery to the two femoral arteries (inguinal arteries) can be placed via a Y-prosthesis. By means of a bypass, the natural blood flow of the organism is artificially diverted in order to restore an adequate supply of oxygen and .
Since this procedure is more invasive and requires a large abdominal incision with usually poor general condition of the person concerned, the prognosis in the acute situation is comparatively poor. In quite a few cases, amputation of the lower limb cannot be avoided. Such an intervention, also referred to as aortobifemoral bypass, is the standard therapy in the presence of chronic Leriche syndrome.
The aortic calcifications and/or clots of the renal artery typical of the chronic variant require special attention on the part of the surgeon during clamping of the aorta. However, if occlusions are hemodynamically well compensated by collateral vessels and the quality of life is not severely impaired, there may be no indication for immediate revascularization (replanting of vessels). Since those affected can be individually and optimally prepared for the surgical procedure, the prognosis is significantly better. Postoperatively, thrombosis prophylaxis and regular follow-up checks are indicated.
Prevention
In order to prevent Leriche syndrome, risk factors should be avoided as far as possible. These primarily include tuxedo stress obesity and high blood pressure. Regular physical activity and a healthy diet with as little animal Fat as possible contribute to the reduction of arteriosclerotic vascular changes and accordingly minimize the risk of disease. In addition, Heart diseases such as cardiac arrhythmias should be adequately treated and controlled in order to reduce the risk of developing acute Leriche syndrome.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.