Leriche syndrome is a vascular disease in which occlusion of the abdominal aorta below the junction of the renal arteries occurs. 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 ICD-10 criteria, Leriche syndrome is defined as atherosclerosis or embolism or thrombosis, respectively, of the abdominal aorta distal to the junction of the renal arteries. Since the occlusion occurs shortly before the aorta bifurcates into the pelvic vessels, it is also referred to as aortic bifurcation syndrome. The condition 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 vasoconstriction develops insidiously over a long period of time, an arterial bypass circulation usually develops, which is associated with reduced perfusion but is not acutely life-threatening. Acute Leriche syndrome, on the other hand, is a dangerous emergency situation.
Causes
Chronic Leriche syndrome is usually caused by arteriosclerosis, which is a degenerative thickening of the vessel wall caused by fatty deposits, calcification, and connective tissue proliferation. More rarely, the cause is vascular inflammation (vasculitis). Acute occlusion is caused by a blood clot that either forms in the abdominal aorta or (far more frequently) is carried there. Heart disease patients are often affected, in whom an embolus is carried from the heart. Patients with artificial heart valves or cardiac arrhythmias are particularly at risk.
Symptoms, complaints, and signs
Chronic Leriche syndrome is manifested primarily by rapid fatigue of the legs, often associated with sensory disturbances, circulatory disturbances, and/or paralysis in the limbs. Some patients present with erectile dysfunction, which may be temporary or permanent. Bladder and bowel dysfunction may also occur, with symptoms varying widely in nature and severity. Some sufferers experience little discomfort, while others are permanently confined to bed or a wheelchair as a result of the disease. Externally, Leriche syndrome can be recognized by the dark purple coloration of the thighs. The skin of affected individuals is usually pale and feels hot in the affected area. Neurological complications often occur due to spinal ischemia. Then the legs can no longer be fully extended or give way during physical exertion. As it progresses, chronic Leriche syndrome can also cause discomfort in the cartilage. If no treatment is given, the above-mentioned symptoms increase in intensity and lead to the death of the patient in 30 to 50 percent of cases. In all cases, if the disease is left untreated, late effects remain, limiting the affected person for life.
Diagnosis and course
Signs of chronic Leriche syndrome include rapid fatigue of the legs, weak to absent groin pulses, impotence problems, pain and cold sensations in the legs, and pale or bluish skin changes. Bladder and bowel functions may also be disturbed. For the diagnosis of acute Leriche syndrome, the so-called 6 P-symptoms according to Pratt are used: pain (pain), pulselessness (pulselessness), pallor (pallor), parasthesia (sensory disturbance), paralysis (paralysis), prostration (shock). Sudden pain in both legs and bilateral absent leg and foot pulses are typical. Neurological complications may also occur because of spinal ischemia. Apparently, the diagnosis can be confirmed by ultrasound Doppler measurement, color-coded duplex sonography, and/ or magnetic resonance angiography.
Complications
In general, Lerisch syndrome may cause limitations and discomfort, but these depend on the individual course of therapy. In most cases, treatment – often in the form of surgery – is positive, which is due to the fact that the disease is usually detected early due to its chronic form and can be treated accordingly as a precaution. The situation would be different if it were an emergency, where rapid action is required and time for solutions is limited.Nevertheless, the usual complaints that can occur after an operation are possible, such as post-operative bleeding or infections. Sometimes water retention may occur, and in rare cases postischemic syndrome may develop due to the ongoing circulatory disturbance. Depending on the size, this can have life-threatening proportions in certain parts of the body. If, contrary to expectations, the recovery process is unfavorable, this can lead to reduced self-esteem or even inferiority complexes in affected individuals, which in the worst case can result in depressive moods.
When should you go to the doctor?
With recurrent circulatory problems or paralysis in the limbs should go to the doctor in any case. People who notice sensation disturbances or suddenly suffer from erectile dysfunction should also seek medical advice. The symptom picture points to Leriche syndrome, which must be clarified and treated quickly. Purple discoloration of the thigh indicates a condition that must be diagnosed immediately and treated if necessary. Sufferers who are bedridden as a result of the condition must have regular medical checkups. Close medical care prevents circulatory problems, sores and other ailments typical of bedriddenness. Those suffering from arteriosclerosis are particularly susceptible to the development of Leriche’s syndrome, and should therefore consult closely with the physician in charge. If described signs occur, this must be clarified within the same week. Patients with artificial heart valves or chronic heart disease are also at risk. They should immediately consult their family doctor, an internist or a cardiologist and have their symptoms investigated.
Treatment and therapy
For the choice of therapy, a distinction must be made between chronic and acute Leriche syndrome. Both forms are treated with vascular surgery. If chronic atherosclerotic aortic occlusion is still incomplete, ablation of vessel wall debris with the aid of a catheter or dilatation and support of the vessel wall with a stent may be considered. Most commonly, in chronic Leriche syndrome, a Y-prosthesis is inserted as a bypass from the abdominal aorta to the inguinal arteries. This operation requires a large abdominal incision; however, because patients with chronic Leriche syndrome enter surgery optimally prepared, the prognosis is nevertheless good. Acute lower body ischemia, on the other hand, requires an emergency procedure. The time window for successful treatment is about 6 hours from the onset of ischemia. In most cases, an initial attempt is made to remove the still fresh and soft clot with an embolectomy catheter. If this is unsuccessful, a Y-shaped bypass must also be used. However, because the patient is usually already in poor general condition, this operation carries a high risk. In addition, postischemic complications can occur even after successful restoration of blood flow. Postoperative thrombosis prophylaxis and regular monitoring are performed. Approximately 3% of bypass recipients experience obstruction of the prosthesis within the first 30 days after surgery. In the literature, the lethality of acute Leriche syndrome is reported to be 30-50%.
Outlook and prognosis
The prognosis is based on the course of the disease and the general condition of the patient. In Leriche syndrome, the triggering clot must first be removed. If this is successful, the symptoms usually resolve rapidly, with no further discomfort to the affected person. If surgical treatment is not possible, therapy can be protracted. The patient must take various measures to alleviate symptoms until the affected clot is identified and removed. If this is successful, the prognosis is good in this case as well. With less burdensome forms of treatment, the prognosis is usually better as well. If surgery can be avoided, the course of the disease can be better managed. In individual cases, a bypass has to be performed. This can restrict the quality of life of the affected person, but has no influence on life expectancy. If the lower extremity has to be amputated, the prognosis is worse. If the disease is treated early, there can be at least symptomatic improvement. However, causal treatment is not very promising in the long term.Affected individuals suffer further calcification, especially in the chronic variant. This can result in clots of the renal artery and other symptoms.
Prevention
Chronic Leriche syndrome is mainly suffered by men from the 5th-6th decade of life, who are heavy smokers, suffer from stress, overweight and hypertension, have a poor diet and little exercise. Prevention can be achieved by all those measures that generally counteract arteriosclerosis: by giving up cigarettes, eating a healthy diet (with special attention to healthy fats), and doing endurance sports and relaxation. It is advisable to take indications of circulatory problems in the lower half of the body, e.g. erectile dysfunction or weak and cold legs, seriously and to have them clarified at an early stage in order to treat aortic stenosis before it becomes threatening.
Follow-up
Leriche syndrome is characterized by the fact that in many cases it goes unnoticed, but can cause great damage to the cardiovascular system and blood vessels. Consistent follow-up care is therefore very important. This means that the physician examines blood lipid values and the functioning of the heart and circulation in regular check-ups and can thus quickly detect negative changes. This can be done by both the family doctor and the internist, and in severe cases involving the heart, also by the cardiologist. For the patient, follow-up care means above all preventing a worsening of atherosclerosis through a consistently considered lifestyle. This includes plenty of exercise, a healthy diet, and abstaining from nicotine and excessive consumption of alcohol. Exercise is therefore also part of aftercare. Aftercare measures can also include participation in sports groups with appropriate indications or nutritional counseling by appropriately trained personnel, for example from health insurance companies or adult education centers. Stress is also a factor that can lead to complications in conjunction with Leriche syndrome. Therefore, follow-up care also applies to stress reduction. Stress reduction is offered by relaxation methods such as autogenic training or progressive muscle relaxation, as well as Far Eastern relaxation methods such as yoga, tai chi or qi gong. These procedures have the advantage that they also have a favorable effect on blood pressure in many cases and positively support recovery.
What you can do yourself
Leriche syndrome results from narrowing of the arteries, with blood clots being a possible cause. It is accompanied by a variety of symptoms. Self-help starts with the accompanying symptoms. Pain relief per se is hardly possible without medication. However, those affected are advised to take it easy and avoid overexertion. Exercise is a particularly effective preventive measure against possible pulselessness and the threat of paralysis. Routine mobilization stimulates blood circulation and improves blood flow. This increases the sensitivity of the skin so that the sensory disturbance can be combated. In addition, the muscles are regularly activated, which prevents slackening and the threat of dysfunction. Adequate hydration is also essential for this. However, this can become a burden for patients in connection with incontinence. For this reason, diapers are a good way to prevent the psychological stress caused by public perception of incontinence. Natural, continence-increasing remedies, such as pumpkin seed extract, can also provide relief. Loss of libido can also be countered with a change in diet. Men in particular are affected by erectile dysfunction. Watermelons act as a natural aphrodisiac.
