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J Gen Intern Med. 2010 October; 25(10): 1102–1104.
Published online 2010 June 22. doi:  10.1007/s11606-010-1412-z
PMCID: PMC2955474

Leriche Syndrome

Michael Frederick, MD,corresponding author1 John Newman, MD, PhD,1 and Jeffrey Kohlwes, MD, MPHcorresponding author2

A 58-year-old man was admitted for coronary angiography after several months of worsening angina. After two failed femoral catheterization attempts due to guide-wire obstruction, access was achieved through the right brachial artery. Catheterization revealed severe three-vessel coronary artery disease. An aortogram was performed revealing a complete occlusion of the aorta inferior to the renal arteries. A computed tomography angiography with runoff demonstrated significant collateral circulation with reconstitution of the distal femoral arteries. (see image 1)An external file that holds a picture, illustration, etc.
Object name is 11606_2010_1412_Figa_HTML.gifOn further history, the patient noted bilateral calf and buttock claudication, erectile dysfunction and a 40-pack year smoking history. Despite complete aortic occlusion, the patient had 1+ palpable posterior tibial and dorsalis pedis pulses due to extensive collateralization. (see image 2)An external file that holds a picture, illustration, etc.
Object name is 11606_2010_1412_Figb_HTML.gif

Leriche syndrome is the triad of claudication, impotence and decreased pulses due to aortoiliac occlusion.1 Risk factors include hyperlipidemia, hypertension, diabetes mellitus and smoking. The Ankle Brachial Index is a non-invasive, inexpensive and reliable method to screen patients.2 Treatment is aimed at relieving the symptoms related to aortic occlusion as well as the prevention of proximal propagation of thrombus. Complete aortic occlusion is treated with open bypass surgery although new endoscopic techniques are on the horizon.3 Our patient had a successful three vessel CABG followed 2 months later by aortofemoral bypass. His claudication completely resolved 3 weeks postoperatively.An external file that holds a picture, illustration, etc.
Object name is 11606_2010_1412_Figc_HTML.gif

Conflict of Interest

None disclosed.

Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Contributor Information

Michael Frederick, Phone: +1-805-2642514, ude.fscu@kcirederF.leahciM.

Jeffrey Kohlwes, Phone: +1-415-7502035, ude.fscu.enicidem@kffej.


1. Leriche R, Morel A. The syndrome of thrombotic obliteration of the aortic bifurcation. Ann Surg. 1943;127(2) [PubMed]
2. Diehm C, Schuster A, Allenberg JR, Darius H, Haberl R, Lange S, Pittrow D, Stritzky B, Tepohl G, Trampisch HJ. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004;172(1):95–105. doi: 10.1016/S0021-9150(03)00204-1. [PubMed] [Cross Ref]
3. Krankenberg H, Schlüter M, Schwencke C, Walter D, Pascotto A, Sandstede J, Tübler T. Endovascular reconstruction of the aortic bifurcation in patients with Leriche syndrome. Clin Res Cardiol. 2009;98(10):657–664. doi: 10.1007/s00392-009-0052-y. [PubMed] [Cross Ref]

Articles from Journal of General Internal Medicine are provided here courtesy of Society of General Internal Medicine