A 31-year old female patient presented with severe low back pain for 12 h. She was known to be suffering from rheumatic mitral stenosis (MS) with atrial fibrillation and had stopped taking all medicines for more than 3 months. Bilateral femoral and lower limb pulses were absent.
Electrocardiogram revealed atrial fibrillation. Echocardiography revealed severe MS with multiple clots in the dilated left atrium [Figure 1]. Emergency cardiac catheterization revealed acute total aortoiliac obstruction proximal to aortic bifurcation [Video 1]. The patient was set up for emergency vascular surgery, but the patient declined any surgical intervention and succumbed to worsening hypotension and shock hours later.
Figure 1: Almost total occlusion of the abdominal aorta by embolic thrombus
This condition was first operated on by Leriche,, who, in 1940, operated on a 29-year-old truck driver who had intermittent claudication and impotence. Eighteen years later, the driver was working and had a 14-year-old boy. The first description, however, was given by Robert Graham in 1814; Leriche syndrome is due to thrombotic occlusion of the abdominal aorta just above its bifurcation. The classic triad of symptoms includes claudication, impotence, and decreased lower extremity pulses., This was classically known to affect young men, but older patients and females have later been described.
Treatment is primarily surgical and includes aortoiliac endarterectomy and aortobifemoral bypass.
Leriche R. De la résection du carrefour aortico-iliaque avec double sympathectomie lombaire pour thrombose artéritique la l'aorte: Le syndrome de l'oblitération termino-aortique par artérite. La Presse Méd Paris 1940;48:601-7.