Leriche syndrome - intermittent buttock pain, erectile impotence, absent femorals due to aortoiliac disease as pudendal artery comes off internal iliac
- Cause of intermittent leg pain due to anaerobic muscle metabolism
- Chronic atherosclerosis/arteriosclerosis
- Buerger's disease, Arteritis, Takayasu's disease
Aetiology of Acute Ischaemia
- Thrombosis of atherosclerotic artery
- Embolism to normal artery
- Aorto-iliac: buttock and thigh and/or calf pain, impotence (Leriche syndrome)
- Iliac-femoral: thigh and/or calf pain
- Superficial femoral-popliteal artery : calf pain
- Age, smoking, HTN, cholesterol, diabetes
- History of MI or TIA or Ischaemic stroke or carotid disease
- Defined as cramp-like pain felt in one or both calves, thighs or buttocks on exertion.
- It may cause the patient to limp.
- The pain recedes
when exertion is stopped and so is intermittent.
- It is a key symptom of peripheral vascular disease and warrants assessment.
- Usually disease is in proximal large and medium-sized arteries
- There is progressive stenosis of the arteries with claudication coming on earlier and earlier.
- Eventually rest pain may occur, this often precedes ischaemia and gangrene of the affected limb.
- Also ischaemic ulcers, gangrene, skin changes, loss of pulses
- Usual risk factors, often male, smoker, hypercholesterolaemia, hypertension etc.
- May have associated vascular disease e.g. stroke or MI
- Important symptoms when pain is at rest in foot or ankle
- Comes on in bed at night and patient holds foot over side of bed
- The limb is pale, cold and painful and pulseless
,li>Absent capillary return
- FBC, U&E (may have CKD), LFTs, ESR, Lipids, Glucose, Hba1C,
- ECG: signs of old MI, AF, LVH
- Elevated lactate with acute ischaemia
- Treadmill for functional claudication distance
- Ankle-Brachial pressure Index ( see ABPI )
- Angiography to look for treatable disease
- Best medical therapy - Aspirin, statin, smoking cessation. BP control, Diabetic control
- Arteriography and possible Angioplasty
- Bypass surgery may be considered in some
- Acute Ischaemia may require emergency revascularisation or amputation