Case review

Question 1

Leriche

Answer 1

Abdominal aortic occlusion
Most commonly atherosclerotic
Clinical triad to call Leriche: impotence, pelvic and thigh claudication, absence of femoral pulses
Acute or chronic
Typically begins near bifurcation and progresses proximally

Collaterals:
Most commonly SMA to IMA (e.g. marginal artery of Drummond, or arc of Riolan, then to superior rectal then to inferior rectal then to iliac system
Other pathways:
Superior to inferior epigastric (Winslow pathway)
Intercostals / lumbars to gluteals to internal iliac to external
Intercostals / lumbars to femoral circumflex to external iliac