ABSTRACT
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Subject(s)
Exercise Therapy , Intermittent Claudication , Cost-Benefit Analysis , Humans , Intermittent Claudication/diagnosis , Intermittent Claudication/therapy , Quality of Life , Treatment OutcomeABSTRACT
Leriche syndrome was diagnosed in three patients aged 63, 71 and 73. They presented with a wide range of neurological symptoms such as impotence, pain or dysfunction of the lower extremities. Because a neurological diagnosis was initially suspected, there was a delay in two of the three patients before palpation for a distal pulse in the lower extremities was performed. A pulse was absent in all three patients. Duplex sonography, MR angiography and CT angiography revealed that a pulse was absent due to aortoiliac occlusive disease, also known as Leriche syndrome. They underwent treatment with covered endovascular reconstruction of the aortic bifurcation (CERAB), aortobifemoral bypass or intravenous thrombolysis. All patients significantly improved after treatment. Physicians should always consider aortoiliac occlusive disease in patients who present with neurological symptoms of the lower extremities and must check for a distal pulse in these patients.
Subject(s)
Aorta, Abdominal/physiopathology , Iliac Artery/physiopathology , Leriche Syndrome/diagnosis , Lower Extremity/physiopathology , Aged , Angiography , Aorta, Abdominal/surgery , Aortic Diseases/diagnosis , Aortic Diseases/physiopathology , Aortic Diseases/surgery , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/physiopathology , Arterial Occlusive Diseases/surgery , Computed Tomography Angiography , Erectile Dysfunction/diagnosis , Erectile Dysfunction/etiology , Female , Humans , Iliac Artery/surgery , Leriche Syndrome/physiopathology , Leriche Syndrome/surgery , Male , Middle Aged , Pain/diagnosis , Pain/etiology , Pulse , Stents , Treatment OutcomeABSTRACT
BACKGROUND: The incidence of delirium following open abdominal aortic aneurysm (AAA) surgery is significant, with incidence rates ranging from 12% to 33%. However, it remains unclear on what level of care a delirium develops in AAA patients. The aim of this study was to investigate the incidence of delirium in the ICU and on the surgical ward after AAA surgery. METHODS: A single-center retrospective cohort study was conducted that included all patients treated electively for an open AAA repair and patients who underwent emergency treatment for a ruptured AAA between 2013 and 2018. The diagnosis of delirium was verified by a psychiatrist or geriatrician using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. The incidence of delirium was calculated. Cox proportional hazards regression analyses were used to analyze 6- and 12-month survival. RESULTS: A total of 135 patients were included, 46 patients (34%) had a delirium during admission. Of these, 30 patients (65%) developed a delirium in the ICU and 16 patients (35%) on the surgical ward. There was no significant difference in six months and twelve months mortality between the ICU and ward delirium groups (HR=1.64, 95% CI: 0.33-8.13, and HR=1.12, 95% CI: 0.28-4.47, respectively). CONCLUSIONS: Delirium frequently occurs in patients who undergo AAA surgery. This study demonstrated that patients on the surgical ward remain at risk of developing a delirium after ICU dismissal. Patients with ICU delirium differ in clinical characteristics and outcomes from patients with a delirium on the surgical ward.
