Leriche Syndrome

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

What is Leriche Syndrome?

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

Since the closure takes place shortly before the aorta forks into the pelvic vessels, it is also called aortic bifurcation syndrome. The disease was named after the French surgeon René Leriche (1979-1955). The arterial occlusion leads to reduced perfusion of the lower half of the body.

If the vascular constriction develops gradually over a longer period of time, an arterial bypass circuit usually arises, which is associated with reduced blood flow, but is not acutely life-threatening. An acute Leriche syndrome, on the other hand, is a dangerous emergency situation.

causes

Responsible for a chronic Leriche Syndrome is mostly arteriosclerosis, d. H. a degenerative thickening of the vessel wall due to fat deposits, calcium and connective tissue overgrowth. More rarely, the cause is inflammation of the blood vessels (vasculitis).

An acute blockage is caused by a blood clot that either forms in the abdominal aorta or (much more often) is carried there. It often affects people with heart disease in whom an embolus is dragged out of the heart. Patients with artificial heart valves or cardiac arrhythmias are particularly at risk.

Symptoms, ailments & signs

Chronic Leriche Syndrome is primarily expressed by the rapid fatigue of the legs, often associated with sensory disturbances, circulatory disorders and / or paralysis in the limbs. Some patients develop erectile dysfunction, which can be temporary or permanent. Bladder and bowel dysfunction can also occur, although the symptoms vary greatly in their nature and severity.

Some sick people hardly feel any discomfort, while others are permanently confined to bed or to a wheelchair as a result of the illness. Externally, the Leriche Syndrome can be recognized by the dark purple color of the thighs. The affected person's skin is usually pale and feels hot in the affected area. The spinal ischemia often leads to neurological complications.

Then the legs can no longer be fully straightened or they give way during physical exertion. In the further course of the chronic leriche syndrome can also cause discomfort to the cartilage. 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, long-term effects remain in the event of an untreated disease, which limit the person affected for a lifetime.

Diagnosis & course

Signs of a chronic Leriche Syndrome are rapid fatigue of the legs, weak to absent groin pulses, erectile dysfunction, pain and feelings of cold 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 (pain), pulselessness (lack of pulse), pallor (paleness), parasthesia (sensory disturbance), paralysis (paralysis), prostration (shock). Sudden pain in both legs and a lack of leg and foot pulses on both sides are typical.

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

Complications

As a rule, Lerisch syndrome can lead to limitations and complaints, 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. It 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, such as secondary bleeding or infections, are possible. Occasionally it can lead to water retention, 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 is unfavorable, this can lead to a reduced self-esteem in the affected person or to inferiority complexes, which in the worst case can lead to depressive moods.

When should you go to the doctor?

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

Sick people who are bedridden as a result of the condition must have regular medical examinations. Close-knit medical care prevents circulatory disorders, sores and other symptoms typical of being bedridden. Anyone who suffers from atherosclerosis is particularly prone to developing 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 the symptoms examined.

Treatment & Therapy