Leriche syndrome

Disease Description (Causes and Symptoms)

• Definition: Leriche syndrome is a condition in which blood flow to the lower extremities decreases because the aortoiliac segment becomes narrowed or occluded due to atherosclerosis at the level of the distal abdominal aorta and both iliac arteries.
• Causes/Pathophysiology: The primary cause is atherosclerosis, with arterial disease risk factors such as hyperlipidemia, hypertension, smoking, and diabetes being associated. Plaque formation in the aorta/iliac arteries → stenosis or complete occlusion → reduced distal blood flow and tissue ischemia. Collateral circulation develops over time, but severe ischemia can occur with acute worsening.
• Main symptoms:
  • Intermittent claudication that occurs when walking: pain, numbness, or muscle cramps, especially in the buttocks, thighs, and calves
  • Weakening or disappearance of the femoral artery pulse
  • In men, impotence and possible infertility due to reproductive or genital-related problems
  • In severe cases, ulcers, necrosis, coldness, or numbness of the lower extremities, and tissue necrosis

Treatment Methods

• Lifestyle modification and risk-factor management
  • Smoking cessation (the single most important measure)
  • Management of blood pressure, blood glucose, and lipids (including statins)
  • Regular aerobic exercise (such as walking exercise within the limits allowed by pain; psychological and rehabilitation programs are recommended)
  • Weight control and a healthy diet
• Drug treatment
  • Antiplatelet agents (aspirin or clopidogrel) to reduce the risk of thrombosis
  • Statins (lipid-lowering drugs) to inhibit the progression of atherosclerosis
  • Symptom-relief medications: cilostazol, etc. (contraindications such as liver disease or heart failure must be checked)
  • Medications to control blood pressure and diabetes
• Procedures and surgery
  • If the distal occlusion is short and accessible, percutaneous transluminal angioplasty (PTA) + stent placement
  • If the lesion is long or complex:
    • Vascular bypass surgery such as aortobifemoral bypass
    • Surgical recanalization procedures such as endarterectomy
  • The choice is determined according to the lesion’s length and location, the patient’s overall condition, and comorbidities
• Emergency treatment/Severe ischemia
  • If acute ischemic symptoms (sudden severe pain, pale or cold skin, loss of sensation or movement) occur, emergency revascularization is required
• Complication management and prognosis
  • If the condition progresses without appropriate treatment, lower-extremity ulcers and necrosis may require amputation
  • If proximal occlusion progresses to the renal arteries, kidney function may worsen
• Precautions (during self-management)
  • Take thorough care of wounds and feet (for early detection of foot ulcers)
  • Avoid extreme cold and trauma
  • Follow instructions before and after surgery/procedures (such as fasting and stopping medications)
  • Criteria for an early emergency call: sudden worsening of pain, pale or bluish skin, or loss of sensation or movement

Outpatient Visit Checklist (Including Preparation Items and Sample Questions)

• Preparation items
  • A list of currently taken medications (including doses and administration times)
  • Past medical history and surgical records (especially cardiovascular disease, diabetes, and kidney disease)
  • Recent test results (blood tests, lipids, blood glucose, kidney function, etc.) and copies of previous vascular imaging (CT/MR/angiography, etc.)
  • A record of symptom changes: when symptoms began, the distance at which pain occurs (walking distance), the characteristics of the pain (location, intensity, and whether it improves with rest), and whether impotence is present and when it began
  • Smoking status (daily amount and duration)
• Materials to show the doctor during the outpatient visit
  • A symptom diary (walking distance and whether symptoms recover after rest)
  • History of taking cardiovascular medications and previous medical treatment
• Preparation for tests
  • Confirm whether anticoagulants/antiplatelet agents are being taken (instructions on stopping them if necessary)
  • If angiography is scheduled, check kidney function and for allergies to contrast media

Examples of General Questions to Ask the Doctor

• "Do I need surgery (or a procedure) for my condition? What are the expected benefits and risks?"
• "What are the expected effects and possible side effects of the recommended medication?"
• "How should I adjust my usual daily activities and exercise after treatment?"
• "What is the long-term prognosis (including lower-extremity function and the risk of amputation)?"
• "What additional tests or follow-up plan are needed to prevent recurrence?"

Examples of Condition-Specific Questions

• "Considering the location and length of my occlusion, would percutaneous stent placement be sufficient, or would bypass surgery be more appropriate?"
• "I also have impotence. How likely is erectile function to recover after vascular recanalization, and what treatment options are available for impotence?"