Abstract | December 16, 2022

Leriche Syndrome: An Unusual Left Lower Extremity Pain

Presenting Author: Shanesse Spratt, MD, Emergency Medicine Resident, PGY1, Department of Emergency Medicine, MRHC, Corinth, MS

Learning Objectives

  1. Effectively discuss alternative differential diagnoses when patients presents with lower extremity pain.

Case Presentation: 79 yo WF with PMH of HTN, HLD, CAD, PAD, tobacco abuse, RLE BKA, femoropopliteal bypass in 1989 presented to the ED with severe LLE pain that awoke her from her sleep.  On physical examination the patient is extremely petite, with tenderness to palpitation of the LLE and the LLE is cold to touch. No palpable pulses. Differential diagnoses include occlusion of LLE DVT, acute arterial occlusion, compartment syndrome and phlegmasia alba dolens. LLE CTA obtained revealed high grades stenosis of abdominal aorta secondary to hyperdense thrombus approximately 80-90% which occludes the bilateral limbs of the aortoiliac bypass graft with chronic occlusion of the native common, external, and internal iliac arteries. Occlusion of right femoropopliteal bypass graft as well as the native SFA and popliteal artery without evidence of reconstitution of flow distally.   Occlusion of left common femoral artery and proximal SFA. Proximal left posterior tibial artery occlusion. Cardiology was consulted with recommendations of initiating heparin drip. Consulted CV surgery and they felt as if there was no intervention to offer patient due to severity of disease. Patient offered transfer to another facility for a second opinion. Patient declined. Patient admitted to ICU.

 

Diagnosis: Leriche Syndrome/Critical Ischemia of LLE

 

Management: General surgery was consulted and a LLE AKA was performed. Patient tolerated the procedure well and was discharged to SNF for rehab.

 

References:

  1. Approach to revascularization for claudication due to peripheral artery disease Authors: Mark G Davies, MD, PhD, MBA, FACS, FACC, Hasan H Dosluoglu, MD, FACS Section Editors:Joseph L Mills, Sr, MD, John F Eidt, MD Deputy Editor: Kathryn A Collins, MD, PhD, FACS
  2. Furrer M, Schüler M, Leutenegger AF, Rüedi T. Akutes Leriche-Syndrom bei einer bisher gesunden Frau: die Differentialdiagnose zum embolischen Verschluss [Acute Leriche syndrome in a previously healthy woman: differential diagnosis of embolic occlusion]. Helv Chir Acta. 1994 Dec;60(6):887-91. German. PMID: 7876006.
  3. Brown KN, Muco E, Gonzalez L. Leriche Syndrome. [Updated 2022 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538248/
  4. Adnor S, El Kourchi M, Wakrim S. When the aortoiliac bifucation is occluded:Leriche syndrome. Ann Med Surg (Lond). 2022 Feb 25;75:103413. doi: 10.1016/j.amsu.2022.103413. PMID: 35386798; PMCID: PMC8977906.
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