Circulación colateral en enfermedad oclusiva aórtica y visceral. Síndrome de Leriche / Collateral pathways on aortoiliac and mesenteric occlusive disease. Leriche syndrome

Introducción: La enfermedad aortoilíaca oclusiva, o enfermedad de Leriche, se presenta mayormente en hombres de 40 a 60 años con antecedentes de hipertensión, tabaquismo, hiperlipemia o diabetes. Su lenta progresión permite el desarrollo de colateralidad arterial compensatoria. Caso clínico: Se trata de un paciente de 53 años con hipertensión arterial y síndrome de isquema crónica de miembros inferiores grado IIb de Fontaine, que presenta en angiotomografía estenosis significativa de ambas arterias renales, oclusión aortoilíaca y de troncos viscerales con importante circulación colateral compensatoria. Discusión: La prevalencia exacta de la enfermedad de Leriche es desconocida, usualmente no evoluciona a isquemia crítica de miembros inferiores gracias a la red colateral que debe ser valorada de cara a la planificación de cualquier intervención en la que pueda verse involucrada. La sospecha clínica debe presentarse ante la tríada clásica: claudicación de miembros inferiores, disfunción sexual y ausencia de pulsos femorales. A pesar de las múltiples opciones quirúrgicas conocidas en la actualidad, el tratamiento individualizarse para cada paciente acorde a la clínica que presente.(AU)

Acute Leriche Syndrome in Pancreatic Adenocarcinoma: A Case Report.

INTRODUCTION: Coexistance of pancreatic carcinoma and Leriche syndrome is an extremely rare pathological condition. Leriche syndrome is defined as occlusion of the distal aorta at the bifurcation into the common iliac arteries. CASE REPORT: We report the case of a 57-year old male patient with a locally advanced pancreatic tumor that during chemotherapy presented Leriche syndrome. Four months after the diagnosis and although the initial staging by MRI had only revealed a few atheromatic lesions of the abdominal aorta, the patient complained about claudication of the legs and hypoesthesia. Angiography with multi-detector computed tomography (MDCTA) was performed using aortography protocol and three-dimensional reconstruction of the images followed, demonstrating the relationship between pancreatic carcinoma and Leriche syndrome. CONCLUSION: Review of the literature revealed that acute abdominal thrombosis is rare in cancer patients. To our knowledge, complete occlusion of the aorta in a patient with pancreatic cancer has not been reported yet.

Leriche syndrome in a patient with acute pulmonary embolism and acute myocardial infarction: a case report and review of literature.

BACKGROUND: Both acute myocardial infarction and acute pulmonary embolism are distinct medical urgencies while they may conincide. Leriche's syndrome is a relatively rare aortoiliac occlusive disease characterized by claudication, decreased femoral pulses, and impotence. We present the first case of concomitant acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome. CASE PRESENTATION: A 56-year-old male with a history of intermittent claudication was admitted for evaluating the sudden onset of chest pain. Elevated serum troponin level, sustained high D-dimer level, ST-T wave changes on electrocardiogram, and segmental wall motion abnormality of the left ventricle on transthoracic echocardiography were noted. Pulmonary Computed Tomography Angiogram revealed multiple acute emboli. Aortic Computed Tomography Angiogram spotted complete obstructions of the subrenal aorta and bilateral common iliac arteries with collateral circulation, maintaining the vascularization of internal and external iliac arteries. We stated the diagnosis of acute pulmonary embolism and Leriche syndrome and initiated oral anticoagulation. However, Q waves on electrocardiogram and wall motion abnormality on echocardiography persisted after embolus dissolved successfully. Coronary computed tomography angiogram found coronary arterial plaques while myocardial Positron Emission Tomography detected decreased viable myocardium of the left ventricle. We subsequently ratified the diagnosis of concurrent acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome. The patient was discharged and has been followed up at our center. CONCLUSION: We described the first concurrence of acute pulmonary embolism, acute myocardial infarction, and Leriche syndrome.

[The efficacy of ticlid in treating intermittent claudication in atherosclerotic stenosis of the arteries of the lower extremities]. / Effektivnost' tiklida pri lechenii peremezhaiushcheisia khromoty u bol'nykh s ateroskleroticheskim stenozirovaniem arterii nizhnikh konechnostei.

Serious affections of hemostasis were found in hemostatic examinations involving 67 intermittent claudication patients resistant to longterm vasodilative drugs. A 4-6-month course of tiklid (500 mg daily) induced a significant fall in platelet aggregation and an increase in the blood fibrinolytic activity, decreased foot chilliness, pain while walking. 73% of the patients could cover longer distances without pain complaints.

[Spontaneous lysis of acute Leriche syndrome]. / Spontanlyse eines akuten Leriche-Syndromes.

Usually, obstructions of the terminal aorta require surgery involving an aortobifemoral bypass, especially if they occur with acute signs and symptoms, the clinical pattern of these signs being very marked. The authors report on a case where an extensive obstruction of the lumbar aorta and of the pelvic vessels finally dissolved without on-target therapeutic intervention via an obviously spontaneous lysis.

[Blood rheological disorders in atherosclerotic lesion of the abdominal aorta and their correction by the use of aspirin]. / Gemoreologicheskie narusheniia u bol'nykh s ateroskleroticheskim porazheniem briushnoi aorty i ikh korrektsiia s ispol'zovaniem aspirina.

The initial hemorheologic values and their dynamics in various periods after reconstructive operations were studied in 70 patients with atherosclerosis of the abdominal aorta. The rheologic blood properties proved to be considerably changed in atherosclerotic affection of the abdominal aorta. The causes of the hemorheologic disorders in this pathological condition are marked changes in regional hemodynamics and the character of the blood flow and significant disorders of protein, lipid and carbohydrate metabolism. Study of the effect of aspirin on the rheologic properties of blood in this contingent of patients showed the expediency of its use both in preoperative management and in the postoperative period. Aspirin reduces significantly the degree of blood platelet aggregation and the seeming viscosity of blood.