Leriche's syndrome or aortoiliac occlusive disease is a group of symptoms that develop due to peripheral arterial disease in the legs. The French surgeon Rene Leriche first studied and described the condition, which obstructs blood flow in the abdominal aorta of the stomach before this largest artery splits into the iliac arteries to both legs. The blockage interrupts blood flow to the legs and kidneys and also interferes with blood flow to the genitals.

Peripheral Artery Disease

The occurrence of peripheral artery disease or PAD increases with age and it is most common in older populations, but Leriche's syndrome (LS) can occur in younger people. Men have a higher risk overall for both PAD and LS. Other risk factors include diabetes, renal disease, and hyperlipidemia, a general term for high levels of lipids, such as cholesterol or triglycerides, circulating in the blood.

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Leriche's syndrome is a result of plaque building up on arterial walls and forming blockages -- fat embolisms -- that interfere with circulating oxygenated blood. Unstable blockages can break apart and travel to other blood vessels, an embolizing process. The loose material eventually reaches a smaller blood vessel and causes complete obstruction. Embolisms can block arteries or veins; doctors commonly treat them by placing filters inside blood vessels to catch the material as it travels.

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Classic Symptoms

A classic triad of symptoms is the most recognizable characteristic of Leriche's syndrome: claudication of the buttocks and thighs, absent or weak peripheral pulses in the lower extremities, and erectile dysfunction. Intermittent claudication is an aching or squeezing pain that normally starts during repetitive exercises such as walking uphill or climbing stairs and intensifies as the activity continues.

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Unspecified Symptoms

The three classic symptoms of Lerche's syndrome are not always present. Claudication in the calf muscles is usually more severe and noticeable than claudication in the buttocks thanks to the extensive network of blood vessels in the latter, which can often bypass a blockage. Sometimes symptoms are reported as fatigue while walking or exercising, instead of pain. These factors may lead to a mistaken diagnosis.

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Medical history is important for diagnosing Leriche's syndrome. A history of vascular surgery or recurring pain in the calves raises suspicion of an arterial blockage. Imaging techniques such as abdominal ultrasonography, Doppler ultrasounds, and computed tomography help doctors confirm a diagnosis and find blockages. Hypertension, coronary artery disease, myocardial infarction, and stroke are associated with Leriche's syndrome.

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The same actions recommended for cardiovascular health, in general, can help prevent Leriche's syndrome. A low-fat diet, exercise, and avoiding tobacco products are important. Regular blood tests to monitor cholesterol levels and maintaining a healthy weight reduce the risk of developing PAD. Doctors may request people at risk come in for regular monitoring of hypertension to ensure blood pressure remains within normal limits. These people should also control blood sugar to avoid or manage diabetes.

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Treatment of Leriche's Syndrome

Treatment for Leriche's syndrome starts with antiplatelet therapy and addressing underlying conditions. Surgical intervention is usually the next step. Aortoiliac angioplasty involves inserting a balloon into the artery to compress the plaque against arterial walls, forcing an opening. An endarterectomy can open the blocked artery and remove the plaque. Bypass surgery uses a synthetic tube to divert blood flow around the blockage.

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Neurogenic Symptoms

Leriche's syndrome may present with neurogenic symptoms such as a loss of function in the lower limbs and back pain. A sudden inability to walk or intense pain alternating with numbness or a burning sensation may be indicators of Leriche's syndrome, even though these symptoms are normally associated with nerve damage or disorders of the nervous system.

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Advanced Symptoms

Severe complications are possible if doctors do not treat Leriche's syndrome early. Intense pain in the feet, legs, and buttocks can become continuous, felt even when muscles are completely at rest. Sores on the legs or feet may not heal and frequently become infected because of compromised circulation. Muscle weakness in the lower body becomes so severe that walking short distances is difficult.

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Long-Term Complications

Advanced Leriche's syndrome is fatal without treatment. Death can result from systemic infection or an embolism reaching the heart or lungs. Tissue death in the intestines, stomach, liver, kidneys, and spleen occurs if blockages in major arteries prevent oxygenated blood from reaching networks of smaller blood vessels around these organs. Arterial blockages in the extremities may result in amputation.

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