Leriche syndrome after visceral aortic revascularization – what now?

Authors

  • Rita Bento Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal https://orcid.org/0000-0003-2574-5255
  • Gonçalo Alves Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, NMS-FCM, Universidade Nova de Lisboa; Lisboa, Portugal https://orcid.org/0000-0003-4255-3677
  • Frederico Bastos Gonçalves Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, NMS-FCM, Universidade Nova de Lisboa; Lisboa, Portugal https://orcid.org/0000-0002-9825-9007
  • Gonçalo Rodrigues Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, NMS-FCM, Universidade Nova de Lisboa; Lisboa, Portugal
  • Rita Ferreira Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, NMS-FCM, Universidade Nova de Lisboa; Lisboa, Portugal https://orcid.org/0000-0002-5502-0194
  • Maria Emília Ferreira Hospital de Santa Marta, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, NMS-FCM, Universidade Nova de Lisboa; Lisboa, Portugal https://orcid.org/0000-0002-2580-7519

DOI:

https://doi.org/10.48750/acv.579

Keywords:

Thoraco-bifemoral bypass, Aorto-bifemoral bypass, Peripheral arterial disease, Aorta, thoracic, Leriche Syndrome, Parallel graft

Abstract

INTRODUCTION: Thoraco-bifemoral bypass (TBF) is an alternative to aorto-bifemoral bypass (ABF) or axilobifemoral bypass for severe aortoiliac occlusive disease. TBF may be particularly useful in select patients with concurrent visceral aortic branch vessel disease, infrarenal aortic occlusions, or after failed ABF. We describe a clinical case of a symptomatic Leriche syndrome in the presence of concurrent visceral aortic branch vessel disease.
CASE REPORT: A 57-year-old male patient with a history of Leriche syndrome and acute thrombosis of the right renal artery with acute kidney injury underwent parallel grafting of the celiac trunk, superior mesenteric artery, and right renal artery 12 months before the current episode. He developed intermittent claudication for very short distances (around 5 meters), with significant limitations for activities of daily living and an inability to carry out his work activity. We decided to perform a TBF bypass through a left thoracotomy, which was uneventful. The patient is asymptomatic and has palpable pedal pulses at the 24-month follow-up. Postoperative computed tomography angiography revealed visceral aorta branches and TBF bypass patency.
CONCLUSION: TBF bypass can be performed with good outcomes for patients with severe AIOD, especially if concomitant visceral/infrainguinal reconstruction is warranted. These results support a continued role for TFB in selected patients.

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References

Crawford JD, Scali ST, Giles KA, Back MR, Fatima J, Arnaoutakis DK, et al. Contemporary outcomes of thoracofemoral bypass. J Vasc Surg. 2019;69:1150-9

Schneider JR. Aortoiliac disease: extra-anatomic bypass. Cronenwett JL, Johnston KW, eds. Rutherford’s Vascular Surgery. 8th ed. Philadelphia: Elsevier Saunders; 2014.Vol 2:1722-42.

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Published

2024-11-02

How to Cite

1.
Bento R, Alves G, Bastos Gonçalves F, Rodrigues G, Ferreira R, Ferreira ME. Leriche syndrome after visceral aortic revascularization – what now?. Angiol Cir Vasc [Internet]. 2024 Nov. 2 [cited 2024 Dec. 2];20(2):87-90. Available from: https://acvjournal.com/index.php/acv/article/view/579

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Section

Clinical Case

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