Show Your Best

1
Show Your Best

• Kolapo DaSilva

2
Case Presentation

• CC
• Pain when walking
• HPI
• Mr S. 50 y.o. male smoker presenting 10/8/08 to
  vascular clinic for bilateral LE claudication
• Pain on ambulation x 1-2 blocks, beginning in
  buttocks, extending to thighs and calves
• Progressively worsening for past 4 years
• Worse when walking uphill/stairs
• Denies nonhealing foot ulcers
• Also complains of erectile dysfunction

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Case Presentation

• PHM, FH
• Non contributory
• PSH
• Ureteral strictures s/p ?recurrent UTIs
• Soc Hx
• ½ PPD x 10 years
• Denies alcohol use

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Case Presentation

• PE
• Pleasant gentleman in NAD
• Wt 59.5 kg, T 36.4
• Neck Negative carotid bruits.
• Chest Clear to auscultation bilaterally.
• Cardiovascular RRR s gallops, rubs, or murmurs.
  
• Abdomen soft and mildly protuberant, bowel
  sounds present. No pulsatile masses. No
  organomegaly.
• Extremities 2 equal radial pulses. Nonpalpable
  femoral pulses bilaterally. Nonpalpable politeal
  and distal pulses bilaterally. No ischemic or
  venostasis changes. ABI 0.5 on right, 0.6 on
  left
• Labs/studies
• ABI (7/25/08) 0.5 on right, 0.6 on left
• Aorto-Iliac Duplex (11/10/08) distal aorta
  occlusion distal to origin of renal arteries.
  Occlusion of the bilateral common iliac arteries.
  

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Case Presentation

• Labs/studies (continued)
• CTA of the abdomen and pelvis and bilateral lower
  extremities
• Crescentic thrombus within the descending aorta,
  extending to below the renal arteries, where
  there is total occlusion
• Common iliac arteries are chronically occluded
  and small
• Enlarged inferior epigastric arteries bilaterally
  which fill the common femoral arteries and
  external iliac arteries in a retrograde fashion
  into the internal iliac arteries.

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Diagnosis?
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Diagnosis

• Leriche Syndrome
• Triad of buttock/leg claudication,
  absent/diminished femoral pulses, and erectile
  dysfunction
• Caused by occlusion of distal abdominal aorta at
  bifurcation into common iliac arteries by
  atheroma
• Usually affects younger males (30-40s)
• Associated with cigarette smoking,
  hypercholesterolemia, not necessarily diabetes
  (smaller vessel disease)

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Diagnosis Mr. Ss Risk Factors

• Leriche Syndrome
• Triad of buttock/leg claudication,
  absent/diminished femoral pulses, and erectile
  dysfunction
• Caused by occlusion of distal abdominal aorta at
  bifurcation into common iliac arteries by
  atheroma
• Usually affects younger males (30-40s)
• Associated with cigarette smoking,
  hypercholesterolemia (pt cholesterol 274 on
  6/5/06 (nl 125-200), not necessarily diabetes
  (smaller vessel disease)

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Treatments

• Aortoiliac bypass graft

• Axillofemoral and femoral-femoral bypass (ax-fem
  fem-fem)

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References

• Wikipedia
• LearningRadiology.com
• UpToDate
• Images obtained via Google Images, IDX Image
  Cast, and LearningRadiology.com