Leriche Syndrome 101

Leriche syndrome is a vascular disease in which the abdominal aorta becomes blocked below the renal arteries. A distinction is made between a chronic and an acute form of Leriche syndrome. The acute variant represents a life-threatening complication and requires emergency vascular surgery.

What is Leriche Syndrome?

Some patients develop erectile dysfunction, which may be temporary or permanent. See AbbreviationFinder for abbreviations related to Leriche Syndrome.

According to ICD-10 criteria, Leriche syndrome is defined as atherosclerosis or embolism or thrombosis of the abdominal aorta (abdominal aorta) distal to the origin of the renal arteries.

Since the occlusion occurs shortly before the aorta forks into the pelvic vessels, it is also referred to as aortic bifurcation syndrome. The clinical picture was named after the French surgeon René Leriche (1979-1955). The arterial occlusion leads to reduced perfusion in the lower half of the body.

If the vasoconstriction develops gradually over a longer period of time, this usually results in an arterial bypass circulation, which is associated with reduced blood flow but is not acutely life-threatening. An acute Leriche syndrome, on the other hand, represents a dangerous emergency situation.

Causes

Arteriosclerosis is usually responsible for chronic Leriche syndrome, ie a degenerative thickening of the vascular wall due to fat deposits, calcium and connective tissue proliferation. Rarely, the cause is an inflammation of the blood vessels (vasculitis).

An acute occlusion is caused by a blood clot that either forms in, or (much more commonly) travels to, the abdominal aorta. Cardiac patients, in whom an embolus is carried out of the heart, are often affected. Patients with an artificial heart valve or cardiac arrhythmias are particularly at risk.

Symptoms, Ailments & Signs

Chronic Leriche syndrome is primarily expressed by rapid tiring of the legs, often associated with sensory disturbances, circulatory disorders and/or paralysis in the limbs. Some patients develop erectile dysfunction, which may be temporary or permanent. Bladder and bowel dysfunctions can also occur, with the symptoms varying greatly in type and severity.

Some sufferers feel little discomfort, while others are permanently bedridden or confined to a wheelchair as a result of the condition. Externally, Leriche syndrome can be recognized by the dark purple coloring of the thighs. People’s skin is usually pale and feels hot in the affected area. Neurological complications often occur due to spinal ischemia.

Then the legs can no longer be fully stretched or give in during physical exertion. As it progresses, chronic Leriche syndrome can also cause cartilage problems. If no treatment is given, the symptoms mentioned increase in intensity and lead to the death of the patient in 30 to 50 percent of cases. As a rule, if the disease is left untreated, there will be long-term consequences that will restrict those affected for the rest of their lives.

Diagnosis & History

Signs of chronic Leriche syndrome are rapid tiring of the legs, weak to no groin pulse, erectile dysfunction, pain and feelings of coldness in the legs, and pale or bluish skin changes.

Bladder and bowel functions can also be disturbed. The so-called 6 P symptoms according to Pratt are used to diagnose acute Leriche syndrome: pain, pulselessness (lack of pulse), pallor (pallor), parasthesia (sensory disturbance), paralysis (paralysis), prostration (shock). Typical symptoms are sudden pain in both legs and missing leg and foot pulses on both sides.

Neurological complications can also occur because of spinal ischemia. The diagnosis can be confirmed by means of ultrasound Doppler measurement, color-coded duplex sonography and/or magnetic resonance angiography.

Complications

As a rule, Lerisch syndrome can lead to limitations and symptoms, which, however, depend on the individual course of therapy. In most cases, the treatment – often in the form of an operation – is positive, which is due to the fact that the disease is usually recognized early due to its chronic form and can be treated accordingly as a precaution. The situation would be different if it were an emergency where quick action is required and there is only limited time for solutions.

Nevertheless, the usual symptoms that can arise after an operation are possible, such as bleeding or infections. Sometimes water retention can occur, in rare cases a post- ischemic syndrome can develop due to the persistent circulatory disorder. Depending on the size, this can be life-threatening in certain parts of the body.

If, contrary to expectations, the recovery process goes unfavorably, this can lead to reduced self-esteem or inferiority complexes in the affected person, which in the worst case can lead to depressive moods.

When should you go to the doctor?

If you have recurring circulatory disorders or paralysis in your limbs, you should always see a doctor. People who experience sensory disturbances or who suddenly experience erectile dysfunction should also seek medical advice. The symptoms indicate Leriche syndrome, which must be quickly clarified and treated. A purple discoloration of the thigh indicates a condition that requires immediate diagnosis and treatment if necessary.

Patients who are bedridden as a result of the condition must be examined by a doctor on a regular basis. Close-meshed medical care prevents circulatory disorders, sore spots and other symptoms typical of being confined to bed. Anyone suffering from arteriosclerosis is particularly susceptible to the development of Leriche syndrome and should therefore consult the responsible doctor closely. If the signs described occur, this must be clarified in the same week. Patients with an artificial heart valve or chronic heart disease are also at risk. You should see your family doctor, an internist, or a cardiologist immediately and have your symptoms evaluated.

Treatment & Therapy

When choosing therapy, a distinction must be made between chronic and acute Leriche syndrome. Both forms are treated with vascular surgery. If a chronic arteriosclerotic aortic occlusion is still incomplete, the vessel wall deposits can be removed using a catheter or the vessel wall can be expanded and supported using a stent.

Most commonly, a Y prosthesis is inserted as a bypass from the abdominal aorta to the inguinal arteries in chronic Leriche syndrome . This surgery requires a large abdominal incision; However, since patients with chronic Leriche syndrome go to the operating room optimally prepared, the prognosis is still good. Acute ischemia of the lower half of the body, on the other hand, requires emergency surgery. The time window for successful treatment is approximately 6 hours from the onset of ischemia.

In most cases, an attempt is first made to remove the still fresh and soft clot with an embolectomy catheter. If this is not successful, a Y-shaped bypass must also be used here. However, because the patient is usually in a poor general condition, this operation carries a high risk.

In addition, postischemia complications can occur even after successful restoration of perfusion. Postoperatively, thrombosis prophylaxis and regular check-ups are carried out. Approximately 3% of bypass recipients experience blockage of the prosthesis within the first 30 days after surgery. In the literature, the lethality of acute Leriche syndrome is given as 30-50%.

Outlook & Forecast

The prognosis depends on the course of the disease and the general condition of the patient. In Leriche syndrome, the triggering clot must first be removed. If this is successful, the symptoms usually subside quickly without the affected person having to expect any further symptoms.

If surgical treatment is not possible, the therapy can be lengthy. The patient must take various measures to relieve symptoms until the affected clot is identified and removed. If this is successful, the prognosis is good in this case as well. With less stressful forms of treatment, the prognosis is usually better. If an operation can be avoided, the course of the disease can be better controlled.

In individual cases, a bypass must be placed. This can reduce the quality of life of those affected, but has no effect on life expectancy. If the lower extremity has to be amputated, the prognosis is worse. If the disease is treated early, at least symptomatic improvement can occur. However, causal treatment is not very promising in the long term. The affected persons suffer further calcifications, especially in the chronic variant. This can result in renal artery clots and other problems.

Prevention

Men from the 5th to 6th decade of life who are heavy smokers, suffer from stress, are overweight and have high blood pressure, eat poorly and exercise little suffer from chronic Leriche syndrome. You can prevent it with all those measures that generally counteract arteriosclerosis: by not smoking, healthy nutrition (with special consideration of healthy fats) as well as endurance sports and relaxation. It is advisable to indicate signs of circulatory disorders in the lower half of the body, e.g. E.g. erectile dysfunction or weak and cold legs, should be taken seriously and checked at an early stage in order to treat aortic stenosis before it becomes dangerous.

Aftercare

Leriche syndrome is characterized by the fact that it often goes unnoticed, but can cause major damage to the cardiovascular system and blood vessels. Consistent follow-up care is therefore very important. This means that the doctor examines blood lipid values ​​and the functionality of the heart and circulatory system in regular check-ups and can thus quickly identify negative changes. This can be done by both the family doctor and the internist, and in severe cases with cardiac involvement also by the cardiologist.

For the patient, follow-up care means above all preventing the arteriosclerosis from getting worse by adopting a carefully considered lifestyle. This includes plenty of exercise, a healthy diet, and avoiding nicotine and excessive alcohol consumption. Sporting activities are therefore also part of the aftercare. The aftercare measures can also include participation in sports groups with the appropriate indication or nutritional advice from appropriately trained staff, for example from health insurance companies or adult education centres.

Stress is also a factor that can lead to complications when combined with Leriche syndrome. Therefore, aftercare is also aimed at reducing stress. Stress reduction offers relaxation methods such as autogenic training or progressive muscle relaxation, but also relaxation methods from the Far East such as yoga, Tai Chi or Qi Gong. These procedures have the advantage that in many cases they have a beneficial effect on blood pressure and support recovery.

You can do that yourself

Leriche syndrome results from narrowing of the arteries, with blood clots being a possible cause. It is accompanied by various symptoms. Self-help starts with the accompanying symptoms.

Pain relief per se is hardly possible without medication. However, those affected are advised to take it easy and avoid overexertion. Exercise is the best preventive measure against possible pulselessness and impending paralysis. Routine mobilization stimulates blood circulation and blood circulation works better. This increases the sensitivity of the skin so that the sensory disturbance can be combated. In addition, the muscles are regularly activated, which prevents slackening and impending dysfunction.

Adequate fluid intake is also essential. However, this can become a burden for patients in connection with incontinence. For this reason, diapers are a good way to prevent psychological stress caused by public perception of incontinence. Natural, continence-increasing agents, such as pumpkin seed extract, can also help. The loss of libido can also be counteracted with a change in diet. Men in particular are affected by erectile dysfunction. Watermelons act like a natural aphrodisiac.