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[Atypical Leriche syndrome]
V Bresan1, K Irlbacher, R Bittner
1Charité, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, 13353 Berlin, Germany.
Zeitschrift Fur Kardiologie
|March 27, 2003
Summary
A 73-year-old woman with multiple comorbidities experienced acute limb ischemia due to aortic occlusion. Despite successful embolectomy, she later died from intestinal ischemia, highlighting the critical nature of aortic emergencies.
Area of Science:
- Vascular Surgery
- Cardiology
- Emergency Medicine
Background:
- The patient presented with symptoms suggestive of lower extremity ischemia and neurological deficits.
- Medical history included peripheral artery disease, diabetes mellitus, arterial hypertension, and chronic atrial fibrillation, alongside a history of breast cancer.
Observation:
- Initial CT scan revealed subtotal abdominal aortic occlusion, misdiagnosed as chronic thrombosis.
- The patient rapidly deteriorated with acute ischemic syndrome of the legs, acidosis, and hyperventilation.
- Duplex ultrasound and angiography confirmed acute total infrarenal aortic occlusion.
Findings:
- Surgical intervention revealed complete abdominal aortic obstruction, and embolectomy successfully removed a layered embolus.
- Post-operative improvement was followed by a rapid decline due to extensive small intestine and colon ischemia.
- The patient died on postoperative day 9.
Implications:
- This case underscores the diagnostic challenges and critical importance of timely recognition of acute aortic emergencies.
- A high index of suspicion is crucial for differentiating acute aortic occlusion from chronic conditions, especially in patients with comorbidities.
- Prompt surgical intervention is vital, but the risk of secondary mesenteric ischemia must also be considered in managing complex aortic occlusive diseases.