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Aneurysms and occlusive pathologies of the aorta are frequently associated with atherosclerosis; however, thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare condition with challenging treatment strategy and without established surgical treatment protocols. In this report, we present our treatment strategy in a 64-year-old male patient with ischemic heart disease and type 5 thoracoabdominal aortic aneurysm accompanied by Leriche syndrome.

Leriche syndrome was diagnosed in three patients aged 63, 71 and 73. They presented with a wide range of neurological symptoms such as impotence, pain or dysfunction of the lower extremities. Because a neurological diagnosis was initially suspected, there was a delay in two of the three patients before palpation for a distal pulse in the lower extremities was performed. A pulse was absent in all three patients. Duplex sonography, MR angiography and CT angiography revealed that a pulse was absent due to aortoiliac occlusive disease, also known as Leriche syndrome. They underwent treatment with covered endovascular reconstruction of the aortic bifurcation (CERAB), aortobifemoral bypass or intravenous thrombolysis. All patients significantly improved after treatment. Physicians should always consider aortoiliac occlusive disease in patients who present with neurological symptoms of the lower extremities and must check for a distal pulse in these patients.

Leriche syndrome, otherwise known as aortoiliac occlusive disease, is a result of atherosclerotic changes in the distal abdominal aorta, iliac arteries and/or common femoral arteries. Clinical manifestation includes a triad of symptoms: buttock claudication, impotence, and femoral pulselessness. Covered endovascular reconstruction of the aortic bifurcation (CERAB) is one of the new methods that can be used in the treatment of such lesions. Our aim is to present our clinical experience with this technique

OBJECTIVES Patients scheduled for transcatheter aortic valve implantation (TAVI) treatment frequently present with concomitant aortic diseases, in which case they are usually considered to be at high interventional risk and, in particular, unable to undergo the transfemoral TAVI approach. Since the establishment of the ‘transfemoral first’ strategy for TAVI, there has been an evidence gap with regard to the outcomes of such patients. We aimed to evaluate the mid-term outcomes after transapical TAVI in patients with diverse aortic diseases. METHODS Fifty-five consecutive elderly patients (78.4 years; standard deviation: 8.6 years) at intermediate surgical risk with severe aortic stenosis and aortic diseases (porcelain aorta 36%, ascending aneurysm 15%, descending aneurysm 26%, type-B dissection 4%, aortic thrombus 7%, Leriche syndrome 4%, aortic kinking 11%, aortic ulcer 2%, previous aortic operation 20%, aortic elongation/tortuosity 4%) underwent transapical TAVI treatment between January 2011 and November 2019 at our institution. We used the second-and third-generation self- and balloon-expanding valves. The follow-up time was 92.6 patient-years. RESULTS The Society of Thoracic Surgery-Predicted Risk of Mortality score was 7% (standard deviation: 4%). The 30-day mortality and all-stroke rates were 6% and 4%, respectively. The median survival time was 24.9 months (95% confidence interval 17.6–32.3). The median time of freedom from a composite of death and cardio-cerebral adverse events was 24.3 months (95% confidence interval 11.9–36.8). The rate of moderate/severe paravalvular leakage was 2%. The pacemaker rate was 10%. No early or late aortic syndrome occurred. CONCLUSIONS Transapical TAVI is a safe method and shows very promising early and mid-term outcomes, without early/late aortic syndrome, in patients with aortic diseases for whom transfemoral TAVI as the first-line transcatheter method might be contraindicated or not feasible.

The aim of the study was to compare the hemodynamic effects of endoluminal and open surgical treatment of chronic Leriche syndrome using arterial collaterals on CTA as a surrogate parameter. This retrospective, single-center study included 30 patients with chronic Leriche syndrome. Fourteen patients underwent intraluminal stent implantation (endo group), and sixteen underwent surgical bypass grafting (surgical group). CTA was performed pre- and postoperatively, and a series of evaluation parameters (a1: sum of area of the systemic collateral pathways in the abdominal wall before operation, a2: sum of area of the systemic collateral pathways in the abdominal wall after operation, ar: area of lumen of the stent or artificial vessel, BSR: post- and preoperative blood supply ratio = (a2 + ar)/a1, RR: reduction rate of systemic collateral arteries after the operation = (a1−a2)/a1) were defined to quantitatively evaluate the hemodynamic effects of the treatments. Short-term clinical outcomes, including improvement of symptoms, postoperative complications and in-hospital stay, were also collected. Then, the effects of the two operations were compared. There was no significant difference in the baseline (a1, p = 0.301) and postoperative (a2, p = 0.802) collateral arteries, as well as BSR (p = 0.088) and RR (p = 0.592) between endo and surgical groups. There was also no significant difference in short-term clinical outcomes between the two groups. Our limited series suggests that intraluminal stent implantation may not be inferior to surgical bypass grafting regarding the undifferentiated short-term clinical outcomes as well as the chosen hemodynamic surrogate parameters.

Introduction We treated a patient with late-stage unilateral bypass thrombosis after bilateral axillary-femoral bypass with lateral axillary-profunda femoris artery (LAx-PF) bypass. Case presentation A 64-year-old male patient was admitted to our hospital for acute left lower limb ischemia. Six years ago, he underwent bilateral axillary-femoral bypass due to Leriche syndrome. On emergency admission, thrombosis of the left bypass vessel was identified. Blood flow could not be restored due to failure to restore patency of the proximal and distal anastomosis of the left bypass vessel during surgery. We performed LAx-PF bypass surgery to successfully rescue the limb, which was on the verge of necrosis. Conclusion If thrombectomy cannot restore blood flow in the previous axillary-femoral bypass, LAx-PF bypass is an easy procedure to rescue the ischemic limb.

Background Transcarotid transcatheter aortic valve implantation (TAVI) is a worthwhile substitute in patients who might otherwise be inoperable; however, it is applied in Case summary We report a case of concomitant transcarotid TAVI and carotid endarterectomy (CEA) in a patient with bovine aortic arch and previous complex infrarenal EndoVascular Aortic Repair (EVAR). The integrity and positioning of the previous EVAR endograft was risked by transfemoral access. The right subclavian artery was only 4.5 mm and the left subclavian was totally occluded so transcarotid access was chosen. The patient recovered well, with no neurological deficit and was discharged home after 72 h. He was last seen and was doing well 6 months post-procedure. Discussion In patients with severe aortoiliac disease, or previous aortic endografting, transfemoral access for TAVI can be challenging or even prohibitive. Alternative access sites such as transapical or transaortic are associated with added risk because they carry increased risk of major adverse cardiovascular events, longer intensive care unit and hospital stay, and increased cost. A transcaval approach for TAVI has also been reported but was not suitable for our patient due to prior EVAR. Concomitant TAVI via transcarotid access and CEA can be successful in experienced hands. This case highlights the importance of a team-based approach to complex TAVI cases in high-risk patients with complex vascular access.

Background and objectives: Patients with obstruction or stenosis of the aorta and iliac arteries or with aortic aneurysm, often co-existing with iliac artery aneurysms, suffer from sexual disorders because of insufficient perfusion to the pelvic organs and penis. This is often the cause of visits to a medical doctor&rsquo, s office with reports of a difficult life situation and a problem with the satisfactory completion of sexual intercourse. A low percentage of vascular surgeons or angiologists are prepared to talk about issues related to the hereditary sphere with a patient who qualifies for the treatment of Leriche syndrome or abdominal aortic aneurysm. The aim of this study was to analyze sexual disorders in men with infrarenal abdominal aortic aneurysm treated by stent-graft or prosthesis implantation. Material and methods, Outcomes: 38 patients who completed the IIEF-5 (International Index of Erectile for Men) questionnaire are presented. Initially, 146 qualified for the study after meeting the study inclusion criteria for surgery (Group 1) or for endovascular treatment of abdominal aortic aneurysm (Group 2). Results: In the study, no negative impact of smoking was found, however, over 95% of respondents had been smoking for many years in both groups. Patients who qualified for vascular prosthesis implantation were subject to a more advanced atherosclerotic process involving the aorta and iliac arteries. Patients who qualified for stent-graft implantation were twice as often treated for coronary vessel stenosis. In Group 1, the percentage differences, as shown by questions 1 and 5, were statistically significant (58, i.e., 25%, and 40, i.e., 29%). Conclusions: Education should target medical personnel in terms of conversations with patients, as well as men who are directly affected by this problem, although their partners and families should not be neglected in these activities. The ability to communicate properly allows for an open dialogue on issues that the patient finds difficult, particularly in the field of sexology.

We read with great interest the article by Bosse and colleagues,1 in which they presented a case series of cardiac surgery combined with bypass from the ascending aorta to the bilateral femoral arteries in patients with severe aorta-iliac occlusion.

We report a case of Tangier disease with Leriche syndrome and bleeding tendency. In this male patient, nasal hemorrhage had been observed frequently throughout childhood. At 46 years old, he experienced effort angina, and coronary angiography demonstrated 75% stenosis in the right coronary artery. Orange-colored tonsils, mild hepatosplenomegaly and very low levels of serum high-density lipoprotein cholesterol (HDL-C) were observed, and the patient was diagnosed with Tangier disease. At 52 years old, effort angina recurred. Coronary angiography revealed 75% stenosis of the left main trunk, left anterior descending, and right coronary arteries. Stenosis of the brachiocephalic and right common iliac arteries was also recorded. Stents were implanted, and coronary artery bypass surgery was performed. At 53 years old, 15 months after surgery, the patient reported intermittent claudication, coldness of feet, and impotence. Aortic angiography showed progression of the stenosis at the bifurcation of the common iliac artery. The patient was diagnosed with Leriche syndrome, and aorta-left external iliac artery graft bypass surgery was performed. After surgery, oozing from subcutaneous tissue and leaking from the anastomotic region were observed. Additional analysis revealed two single-nucleotide polymorphisms (V825I and N935T) in the ATP-binding cassette transporter A1 (ABCA1) gene, and accumulation of small dense low-density lipoprotein together with low levels of HDL-C. In Tangier disease, HDL-C is markedly decreased because of ABCA1 deficiency. However, this is the first reported case to exhibit extensive atherosclerosis and bleeding tendency. This patient had atypical extensive and multiple atherosclerotic lesions, accompanied by Leriche syndrome and uncontrollable bleeding.

The last decade has seen distinct dynamics of the worldwide growth of the number of endovascular interventions and a decrease in the number of 'open' surgical operations for pathology of the aorta and peripheral arteries. The world trends of treatment of patients presenting with pathology of the aorta and peripheral arteries are indicative of a steadily growing amount of operations, most of which are performed in an endovascular manner. In the Russian Federation, the past decade has also witnessed a noticeable jump of the amounts of endovascular interventions. Thus, the number of operations from 2008 to 2017 increased from 15 094 to 37 109 (2.5-fold). Nevertheless, in Russia there is a significant lag in both the total amount and the ratio of the performed surgical and endovascular operations in patients with pathology of the aorta and peripheral arteries. The article analyses the world and Russian trends in the development of surgical and endovascular treatment of patients with pathology of the aorta and peripheral arteries.За последнее десятилетие в мире сохраняется отчетливая динамика роста числа эндоваскулярных вмешательств и уменьшение количества 'открытых' хирургических операций при патологии аорты и периферических артерий. Мировые тенденции лечения больных с патологией аорты и периферических артерий указывают на постоянно растущий ежегодный объем операций, наибольшее количество из которых выполняются эндоваскулярно. В Российской Федерации за последние 10 лет также произошел заметный скачок объемов эндоваскулярных вмешательств. Так, количество операций с 2008 по 2017 гг. увеличилось с 15 094 до 37 109 (в 2,5 раза). Тем не менее в нашей стране имеется значительное отставание как в общих объемах, так и в соотношении выполняемых хирургических и эндоваскулярных операций у больных с патологией аорты и периферических артерий. В статье проанализированы мировые и российские тенденции развития хирургического и эндоваскулярного лечения больных с патологией аорты и периферических артерий.

El síndrome de Leriche es una condición causada por la obstrucción de las ramas principales de la aorta abdominal por debajo de la salida de las arterias renales con compromiso de todo el árbol arterial, incluyendo las iliacas y femorales. Se presenta un paciente masculino de 62 años de edad con antecedentes de tabaquismo y que consulta al servicio de urgencias por un cuadro clínico de 3 meses de evolución consistente en dolor de miembros inferior, linfedema que predomina en el miembro inferior izquierdo, además de ausencia de pulsos en miembros inferiores. Al aplicar el test IIEF-5 se obtiene una disfunción eréctil moderada. Es importante resaltar este síndrome y la necesidad de diagnosticarlo tempranamente debido a sus consecuencias catastróficas, haciendo énfasis en identificar e intervenir en los factores de riesgo que conllevan a esta presentación inusual de la enfermedad arterial periférica. Leriche syndrome is a condition caused by obstruction of the main branches of the abdominal aorta below the outlet of the renal arteries, with involvement of the entire arterial tree, including the iliac and femoral arteries. . We present a 62-year-old male patient with history of smoking who consults the emergency department with clinical features of a 3-month course consisting in lower limb pain, lymphedema more predominant in the left lower limb, and the absence of pulses in the lower limbs. When applying the IIEF-5 test, moderate erectile dysfunction is found. It`s important to highlight this syndrome and the necessity of an early diagnosis for its consequences can be devastating, also to identify and intervene in risk factors that lead to this unusual presentation of peripheral artery disease.

We present the case of a 77-year-old man with a saccular descending thoracic aortic aneurysm who underwent successful antegrade thoracic endovascular aortic repair (TEVAR) via the left axillary artery. The patient had a history of axillo-bifemoral bypass grafting due to aortoiliac occlusive disease (Leriche syndrome), which precluded normal retrograde TEVAR. Upon successful procedure completion, no endoleak was noted on postoperative computed tomography. The patient was discharged from the hospital without any complications. The left axillary artery is useful as an alternative access site in cases wherein conventional retrograde TEVAR is not feasible.

We report a case of Tangier disease with Leriche syndrome and bleeding tendency. In this male patient, nasal hemorrhage had been observed frequently throughout childhood. At 46 years old, he experienced effort angina, and coronary angiography demonstrated 75% stenosis in the right coronary artery. Orange-colored tonsils, mild hepatosplenomegaly and very low levels of serum high-density lipoprotein cholesterol (HDL-C) were observed, and the patient was diagnosed with Tangier disease. At 52 years old, effort angina recurred. Coronary angiography revealed 75% stenosis of the left main trunk, left anterior descending, and right coronary arteries. Stenosis of the brachiocephalic and right common iliac arteries was also recorded. Stents were implanted, and coronary artery bypass surgery was performed. At 53 years old, 15 months after surgery, the patient reported intermittent claudication, coldness of feet, and impotence. Aortic angiography showed progression of the stenosis at the bifurcation of the common iliac artery. The patient was diagnosed with Leriche syndrome, and aorta-left external iliac artery graft bypass surgery was performed. After surgery, oozing from subcutaneous tissue and leaking from the anastomotic region were observed. Additional analysis revealed two single-nucleotide polymorphisms (V825I and N935T) in the ATP-binding cassette transporter A1 (ABCA1) gene, and accumulation of small dense low-density lipoprotein together with low levels of HDL-C. In Tangier disease, HDL-C is markedly decreased because of ABCA1 deficiency. However, this is the first reported case to exhibit extensive atherosclerosis and bleeding tendency. This patient had atypical extensive and multiple atherosclerotic lesions, accompanied by Leriche syndrome and uncontrollable bleeding.

Aortoiliac occlusive disease (AOD) is a rare presentation of thrombosis of the abdominal aorta. Also known as Leriche syndrome, its classic description entails claudication of the buttocks, thighs, and calves, absent femoral pulses, and impotence. AOD risk factors include smoking, hypertension, hyperlipidemia, diabetes, chronic renal insufficiency, and hypercoagulopathy. Ischemic complications of gastrointestinal malperfusion, renal infarction, and paralysis secondary to spinal cord ischemia are also noted. This case describes AOD complicated by a Stanford Type B aortic dissection leading to multi-system organ failure. A brief review of the literature further elucidates the key risk factors in identifying and treating Leriche syndrome.

Se describe el caso de un paciente con factores de riesgo elevados para enfermedad ateroesclerótica que ingresó por dolor en miembros inferiores asociado a úlcera en glande y muñón de pie derecho, además de claudicación intermitente, impotencia sexual y ausencia de pulsos en miembros inferiores, fue valorado integralmente por múltiples especialidades confirmando el diagnóstico de Síndrome de Leriche, quien por su alto compromiso requirió de amputación del miembro inferior derecho. Nuestro interés es resaltar la importancia del examen físico vascular periférico como método de sospecha diagnóstica para la oportuna intervención del paciente con enfermedad vascular periférica y así prevenir futuras complicaciones.

Aim: Although current guidelines recommend surgical revascularization as the first-line therapy for chronic total occlusion of the abdominal aorta (Leriche syndrome), endovascular therapy (EVT) has been increasingly utilized because of the development of new technologies and techniques. EVT has demonstrated durable midterm outcomes for aortoiliac occlusive disease (AIOD). Nonetheless, little is known regarding their long-term outcomes and predictors of restenosis. Methods: We retrospectively analyzed a multicenter database of 64 consecutive patients (age, 73 ± 10 years; 64% male; 22% critical limb ischemia) undergoing EVT for aortoiliac occlusive disease between September 2005 and March 2016. The outcome measures were primary and secondary patency, following EVT, calculated using the Kaplan–Meier method. Independent predictors associated with restenosis were assessed using Cox proportional hazard regression model. Results: Technical success was achieved in 61 patients (95%). In total, 214 stents (192 self-expandable stents, 22 balloon-expandable stents) were implanted. During the follow-up of 33 ± 28 months, 11 patients experienced loss of patency. The primary patency rates were 88%, 70%, and 70% at 1, 3, and 5 years, respectively. The secondary patency rates were 98%, 87%, and 77% at 1, 3, and 5 years, respectively. In Cox regression analysis, E-Luminexx stent use (in 29 patients, 48%) was associated with restenosis [hazard ratio, 4.41, P = 0.038]. Conclusion: In this retrospective study, EVT for AIOD demonstrated favorable 5-year patency. E-Luminexx stent implantation was associated with restenosis in this population.

Aortoiliac bypass surgery is the gold standard strategy for removing persistent ischaemia resulting from bilateral aortoiliac occlusive disease, a condition known as Leriche syndrome. However, the impact of aortoiliac bypass surgery on the blood flow of the renal artery is not fully understood. Here, we report a case of worsening renal failure caused by renal steal immediately after aortoiliac bypass for Leriche syndrome. The revascularisation of bilateral renal arteries dramatically improved the patient’s renal function and allowed us to discontinue both haemodialysis and diuretics. This case demonstrates that in rare instances, haemodynamic change induced by aortoiliac bypass surgery affects the arteries feeding other organs. Careful preoperative evaluation for the corresponding branches of the aorta is indispensable. Optimal revascularisation should be performed to avoid serious complications after aortoiliac bypass if the patient is at risk of developing critical ischaemia.

A 56-year-old man presenting with massive melena and loss of consciousness was diagnosed with an infected thoracoabdominal aneurysm, an aortoduodenal fistula, and Leriche syndrome following an evaluation by computed tomography. Emergency surgery for uncontrolled infection included the reconstruction of the superior mesenteric and bilateral renal arteries using a four-branched graft. The aortoduodenal fistula was resected after omental filling, and an enterostomy was performed for feeding. Intestinal reconstruction was performed in two stages. The patient was discharged on postoperative day 48 and was without evidence of recurrence at 23 months postoperatively.

Aortoiliac occlusive disease manifests with a broad spectrum clinically, from asymptomatic disease to critical limb ischemia. Vascular laboratory and axial imaging studies are essential to confirm the lesion and develop an intervention plan. Medical treatment should be initiated early, although it plays a limited role. With recent advances in percutaneous endovascular devices, a variety of minimally invasive solutions exist with favorable long-term patency and durability. Open surgical endarterectomy and bypass still remain a durable option for patients with advanced disease or failed endovascular therapy.

The problem concerning surgical decision-making in patients with significant atherosclerotic lesions of arteries of more than one basin will, probably, be important for cardiovascular surgeons for more than one decade. Even the centres possessing experience in several thousand cases of successful treatment of multifocal atherosclerosis have from time to time been facing non-trivial clinical situations requiring a non-standard decision the recommendations for which could hardly be found in the guidelines available, if at all. This article describes the technique and immediate results of an operation making it possible to simultaneously carry out revascularization of the myocardium and lower limbs in patients diagnosed as having a critical coronary lesion and Leriche syndrome with no intervention on the abdominal portion of the aorta. Also given is a detailed description of the technique of performing ascending aorta-bilateral femoral arteries bypass combined with coronary artery bypass grafting. Also presented herein are the data from publications having described this operation previously. Our article for the first time demonstrates the findings of intraoperative flowmetry, proving the leading role of the internal thoracic arteries for collateral blood supply of lower limbs in occlusion of the terminal portion of the aorta. This test lays a pathophysiological foundation for the necessity of a simultaneous intervention on the vessels of two basins.

Background Peripheral arterial disease and coronary artery disease are frequently associated. The percutaneous approach may sometimes involve additional difficulties to the coronary artery disease. Clinical case The case is presented on an 82-year-old male patient with multiple cardiovascular risk factors, a Leriche syndrome and axillobifemoral bypass, who was admitted to hospital due to an inferior myocardial infarction. The procedure approach (radial, brachial, or femoral access routes for percutaneous coronary treatment) and associated complications from the procedure are discussed. Conclusion Although technical improvements and/or treatment of peripheral vascular lesions may allow percutaneous coronary intervention, individual risk and benefit in each patient must be assessed.

Objective To evaluate role of multi-detector CT angiography in assessment of various aorto-iliac diseases and display golden clinical application comparative with other imaging methods. Materials and methods Thirty patients with manifestation of aorto-iliac diseases underwent CT angiography of the abdominal aorta and iliac vessels for disease evaluation and further treatment planning. Results On the basis of CT angiographic findings, the study shows prevalence of atherosclerosis varying from small plaques to occlusion as seen in leriche syndrome. Hypertension and diabetes mellitus were the most risk factors. The most common symptoms were lower limb claudication and burning pain. Most aneurysms are seen infra-renal with the predominant size is of 5–7 cm, most aneurysms starts thoracically and shows intramural thrombus. Conclusions MDCT angiography is excellent noninvasive scanning technique for patients suspected of having aorto-iliac occlusive disease, with higher spatial resolution and faster acquisition times, allowing assessment of the aorta and its branches with greater accuracy than other modalities.

René Leriche (1879-1955) was a 20th century French surgeon generally known in medicine for the syndrome that carries his name, namely the Leriche syndrome in the aorto-iliac occlusive disease.This paper is published to mark the commemoration of 60 year since Leriche’s death.Although Dr. Leriche's legacy resides in the domain of vascular medicine, his research enclosed bone pathology and surgical management of pain.Having his surgical training done under professors Mathieu Jaboulay and Antonin Poncet, his friendship and association with Alexis Carrel and William Halsted have contributed to René Leriche's development as a surgeon, researcher and thinker. Following the footsteps of his mentors, he produced outstanding clinical and academic work which had earned him a good reputation among his students and colleagues. Surgeons such as Jean Kunlin, Jao Cid dos Santos, Michael DeBakey, René Fontaine and others came to study and learn from him. These future generations of surgeons would themselves bring much contribution to the understanding and treatment of vascular diseases and medicine in general.René Leriche pioneered medicine with his research and ideas. His assiduous work of teaching, research and clinical practice made his influence last to our present.