A 32 year old gentleman was referred to us with pain in calf and blackening of toes of his right foot for a week. He gave history of weakness in both lower limbs and erectile dysfunction for past 2 weeks. On examination he had absent femoral arterial pulses bilaterally. The pre-operative CT angiogram showed complete occlusion of juxta renal abdominal aorta with filling of iliac vessels via collaterals.(figure1). The symptoms and angiogram findings are classical features of Leriche syndrome. He had an absent right brachial pulse with occlusion of rt. axillary artery on angiogram. Since the patient was anon smoker the findings were suggestive of aorto arteritis as etiology.
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| Figure 1.-Pre-operative CT - complete occlusion of juxta reanl aorta (arrow) |
In view of his symptomatic status we decided to offer him surgery. A thoraco bifemoral graft was performed. Thoracic aorta was exposed via a lt thoracotomy(black arrow) and using a bifurcated aortic graft vascular supply was restored to both lower limbs (white arrows)relieving his pain and preventing gangrene.
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| Post-operative CT- thoraco bifemoral graft in place with restoration of blood supply. |
Conclusion- Aorto iliac occlusive disease is a serious disease causing lot of morbidity and mortality. Amputation rates are very high in these patients. Atherosclerosis is the most common cause. Smoking is another major cause. Aorto arteritis is a cause in the young. In the symptomatic patients blood supply has to be restored either by surgery or percutaneous intervention to relieve symptoms and prevent amputation.
