Figure 1: There is complete occlusion of the infrarenal abdominal aorta that begins 7 cm inferior to the renal arteries and extends to the iliac arteries. There is reconstitution of flow in the common femoral arteries with retrograde flow through the iliac vessels via the mammary and epigastric collaterals.

Leriche syndrome (aortoiliac occlusive disease).

The infrarenal abdominal aorta and the iliac arteries are the most common sites of obliterative atherosclerosis in patients with symptomatic occlusive disease of the lower extremities. The major risk factors for atherosclerosis include hypertension, elevated levels of LDL, decreased levels of HDL, cigarette smoking, diabetes mellitus, obesity, male sex, elevated homocysteine, and family history of premature atherosclerosis.

The initial manifestation of aortoiliac occlusive disease is intermittent claudication of the lower extremities, usually the buttock, hip, thigh, and calf muscle groups. Leriche syndrome classically presents with impotence, bilateral absence of lower extremity pulses, and lower extremity weakness in young male patients. It is caused by occlusion of a congenitally small aortic bifurcation. The characteristic pathologic finding is a progressive atherosclerotic lesion in the wall of the abdominal aorta with superimposed thrombosis. Some patients with severe incapacitating claudication may also develop limb-threatening ischemia with rest pain and/or ischemic ulcers and gangrene.

Reference:

1. Rutherford, Robert B. Vascular Surgery 4th Edition. Philadelphia: W.B Saunders Company, 1995.