Leriche syndrome is a group of symptoms caused due to blockage in the lower portion of abdominal aorta, just at the junction where it bifurcates into iliac arteries. In medical terminology, the syndrome is also referred as aortoiliac occlusive disease. The characteristic symptoms consist of intermittent pain and spasm of buttocks and thigh, impotence, pale and coldness of lower limbs.
Leriche syndrome develops due to atherosclerotic blockage. The disease is named after the French physician who first described it in 1840. Depending on the severity of occlusion, Leriche syndrome can be treated with lifestyle changes, anti-platelet medication, angioplasty or surgery.
Causes Of Leriche Syndrome
Aorta is a main blood vessel which carries oxygenated blood from heart to different parts of the body. The abdominal aorta bifurcates at the level of belly button into iliac arteries; left iliac and the right iliac. Each branch of iliac artery proceeds in the pelvis and down the legs supplying blood to lower limbs. Leriche syndrome is a type of peripheral artery disease as it affects the peripheral organs of the body, in this case the lower limbs.
Normally, the blood flows smoothly in the arteries. But as the person ages, there is increased risk of plaque formation in the artery.Plaque is made up of calcium, platelets, cholesterol, etc. A big plaque blocks and narrows the artery. The artery becomes stiff and the blood flow is restricted. This process is called atherosclerosis.
When the blood flow in the iliac arteries is compromised, the lower part of body does not receive the amount of oxygenated blood that it requires. Lack of oxygen rich blood may cause pain in the buttocks, thigh and calf region. If the blockage is extreme it may result in ulcers and gangrene of lower limb. The conditions which increase clotting of blood increases the risk of Leriche syndrome.
- Raised level of cholesterol in blood.
- High blood pressure which damages the internal wall of artery and facilitates deposition of lipid and clots.
- Smoking causes increased risk of clotting in the artery.
Leriche Syndrome Symptoms
The classical triad of Leriche syndrome is intermittent cludication of buttocks and lower limbs, impotence in men, and cold feeling in limbs. In the early stage of Leriche syndrome, the patient feels pain in buttocks, thigh and calf muscles when he walks or does exercise. As soon as he rests the pain subsides. This phenomenon is called intermittent claudication.
As the disease progresses, the patient may feel pain even when he walks for a short distance. In the later stage even the toes are painful even during rest.
Since the iliac arteries also supplies blood to pelvis, some men may also suffer from difficulty in erection and its maintenance.
In case of severe obstruction, the other symptoms are:
- Decreased pulse in lower limbs.
- Coldness and pain in toes and feet.
- Weakness of muscles of lower leg.
- Ulcers on lower leg.
- Gangrene in toes and lower leg. In gangrene the tissues die due to complete cut off of blood supply due to obstruction of the clot.
Doppler ultrasound and angiography helps to detect the blockage in the lower end of aorta and the junction of bifurcation of iliac arteries.
Treatment Of Leriche Syndrome
The usual treatment of Leriche syndrome is surgery or putting stents at the site of obstruction.
Lifestyle changes and medications are also important and recommended along with it. Lifestyle changes include quitting smoking, controlling blood cholesterol by eating healthy food that contains less of saturated fats and more of unsaturated fats.
It is important to maintain optimal weight if you are obese. Restrict salt intake if you are having high blood pressure. Control diabetes with medication and healthy eating habits. Physician may recommend medication for controlling high blood pressure. He may also recommend anti platelet medications.
If the blockage is extensive, it has to be treated with angioplasty or bypass surgery to relieve obstruction.