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Show Your Best

Show Your Best. Kolapo DaSilva. Case Presentation. CC Pain when walking HPI Mr S. – 50 y.o . male smoker presenting 10/8/08 to vascular clinic for bilateral LE claudication Pain on ambulation x 1-2 blocks, beginning in buttocks , extending to thighs and calves

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Show Your Best

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  1. Show Your Best Kolapo DaSilva

  2. Case Presentation • CC • Pain when walking • HPI • Mr S. – 50 y.o. male smoker presenting 10/8/08 to vascular clinic for bilateral LE claudication • Pain on ambulation x 1-2 blocks, beginning in buttocks, extending to thighs and calves • Progressively worsening for past 4 years • Worse when walking uphill/stairs • Denies nonhealing foot ulcers • Also complains of erectile dysfunction

  3. Case Presentation • PHM, FH • Non contributory • PSH • Ureteral strictures s/p ?recurrent UTIs • Soc Hx • ½ PPD x 10 years • Denies alcohol use

  4. Case Presentation • PE • Pleasant gentleman in NAD • Wt 59.5 kg, T 36.4 • Neck: Negative carotid bruits. • Chest: Clear to auscultation bilaterally. • Cardiovascular: RRR s gallops, rubs, or murmurs. • Abdomen: soft and mildly protuberant, bowel sounds present. No pulsatile masses. No organomegaly. • Extremities: 2+ equal radial pulses. Nonpalpable femoral pulses bilaterally. Nonpalpable politeal and distal pulses bilaterally. No ischemic or venostasis changes. ABI – 0.5 on right, 0.6 on left • Labs/studies • ABI (7/25/08): 0.5 on right, 0.6 on left • Aorto-Iliac Duplex (11/10/08): distal aorta occlusion distal to origin of renal arteries. Occlusion of the bilateral common iliac arteries.

  5. Case Presentation • Labs/studies (continued) • CTA of the abdomen and pelvis and bilateral lower extremities • Crescenticthrombus within the descending aorta, extending to below the renal arteries, where there is total occlusion • Common iliac arteries are chronically occluded and small • Enlarged inferior epigastric arteries bilaterally which fill the common femoral arteries and external iliac arteries in a retrograde fashion into the internal iliac arteries.

  6. Diagnosis?

  7. Diagnosis • Leriche Syndrome • Triad of buttock/leg claudication, absent/diminished femoral pulses, and erectile dysfunction • Caused by occlusion of distal abdominal aorta at bifurcation into common iliac arteries by atheroma • Usually affects younger males (30-40s) • Associated with cigarette smoking, hypercholesterolemia, not necessarily diabetes (smaller vessel disease)

  8. Diagnosis – Mr. S’s Risk Factors • Leriche Syndrome • Triad of buttock/leg claudication, absent/diminished femoral pulses, and erectile dysfunction • Caused by occlusion of distal abdominal aorta at bifurcation into common iliac arteries by atheroma • Usually affects younger males (30-40s) • Associated with cigarette smoking, hypercholesterolemia (pt cholesterol 274 on 6/5/06 (nl 125-200), not necessarily diabetes (smaller vessel disease)

  9. Treatments Aortoiliac bypass graft Axillofemoral and femoral-femoral bypass (ax-fem fem-fem)

  10. References • Wikipedia • LearningRadiology.com • UpToDate • Images obtained via Google Images, IDX Image Cast, and LearningRadiology.com

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