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[A thromboembolic event rarely occurs alone].

Valerie Bernays1, Nicolas Attigah2, Michael Bigger1

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Summary

Acute Leriche syndrome, a critical aortoiliac occlusion, presents with leg weakness and pulselessness. Despite prompt intervention, this case highlights the high mortality associated with this severe vascular emergency.

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Area of Science:

  • Vascular Surgery
  • Emergency Medicine
  • Cardiology

Background:

  • Acute Leriche syndrome involves occlusion of the aortoiliac segment.
  • Clinical presentation can include progressive bilateral leg weakness and absent foot pulses.
  • Associated conditions like hypertension, obesity, and nicotine abuse are common.

Purpose of the Study:

  • To report a case of acute Leriche syndrome with bilateral pulmonary embolisms.
  • To emphasize the diagnostic challenges and clinical manifestations.
  • To discuss the management and outcomes of this critical condition.

Main Methods:

  • A 65-year-old female patient with relevant medical history presented with leg weakness.
  • Clinical examination revealed paraparesis and absent foot pulses.
  • CT angiography diagnosed Leriche syndrome and bilateral pulmonary embolisms; emergency thrombectomy was performed.

Main Results:

  • The patient experienced acute hypoxemia and shock (cardiogenic and hypovolemic) post-intervention.
  • Reperfusion syndrome and pulmonary embolism were significant complications.
  • Despite aggressive management, the patient succumbed to complications.

Conclusions:

  • Acute Leriche syndrome requires prompt recognition, often aided by the "6 P's" mnemonic.
  • Sensory-motor deficits can be the primary presenting symptom.
  • High mortality persists due to the severity and associated complications, underscoring the need for rapid revascularization.