Kolapo DaSilva

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

PHM, FH Non contributory

PSH Ureteral strictures s/p ?recurrent UTIs

Soc Hx ½ PPD x 10 years Denies alcohol use

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.

Labs/studies (continued) CTA of the abdomen

and pelvis and bilateral lower extremities Crescentic thrombus

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.

http://www.learningradiology.com/caseofweek/caseoftheweekpix2006/cow201arr.jpg

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)

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)

AORTOILIAC BYPASS GRAFT

AXILLOFEMORAL AND FEMORAL-FEMORAL BYPASS (AX-FEM FEM-

FEM)

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