Lerish's syndrome is an atherosclerotic occlusion of aortic bifurcation, which occurs, as a rule, at the age of forty years. This pathology can slowly progress over time, sometimes over ten years. Often, patients themselves notice the onset of the disease, since its symptoms appear suddenly, which is due to the development of complete vascular occlusion.
The clinic, diagnosis, treatment of Leriche syndrome will be discussed in this article.
The root of the problem
It is well known that the aorta is the largest circulatory artery. At the navel level, it bifurcates, then through the small pelvis it goes to the limbs. But in the event that for some reason (they will be discussed later), the diameter of the aorta, along with both iliac arteries, decreases, this can lead to oxygen starvation. In this case, the organs of the reproductive and genitourinary systems, and in addition, the upper parts of the legs, become the affected area.
This condition is called aortic-iliac occlusion in medicine, and the disease itself is called Lerish’s syndrome. This pathology has many different synonyms, ranging from chronic blockage of the aorta to atherosclerotic thrombosis of the abdominal tissue. This disease has been known in medicine for a long time, but it acquired its current name in honor of the surgeon Rene Leriche, who performed the world's first lumbar sympathectomy of a blocked aorta and resection in the last century.
This syndrome is considered exclusively male pathology. Representatives of the male face it ten times more often than women. At the same time, the age group from forty to sixty years is considered to be a risk group among men. In this case, it is important to keep in mind that chronic aortic obstruction is precisely a set of clinical manifestations, and not an independent disease at all. In this regard, the treatment of the syndrome, together with ignoring the reasons that caused it, will make it possible to achieve a visible improvement in the patient's condition, but will not be able to stop the destructive processes occurring in the aorta.
What are the clinic of Lerish’s syndrome, special examination methods and treatment?
Causes of pathology
If we approach this issue superficially, then there are two main factors contributing to the development of this syndrome, namely, atherosclerosis and nonspecific aortoarteritis. But if we are interested in objectivity, it is necessary to make several important clarifications.
Almost common atherosclerosis, the treatment of which is a very long process, it is customary to explain almost half of all chronic diseases. It is generally accepted that the main risk factors in this case are smoking along with diabetes and hypercholesterolemia. In this regard, then almost half of the entire population of our planet should be at risk. But how then to explain in such a case stubborn statistics that indicate a relatively small actual prevalence of this syndrome?
Approximately the same situation is with Takayasu's disease - nonspecific aortoarteritis. Dear medical guides claim that it can lead the human body to obstruction of the abdominal aorta. But if we touch on the topic of this disease in more detail, it turns out that the causes of its development, along with the underlying mechanisms of occurrence, are still unknown to science.
In addition to these diseases, Lerish’s syndrome can also be the result of certain pathologies whose treatment was carried out in insufficient volume. Among them:
- The presence of an obliterating form of endarteritis and atherosclerosis.
- The development of traumatic thrombosis.
- Congenital aplasia.
- The presence of aortoarteritis of a non-specific nature.
- The development of postembolic occlusion.
- The development of muscle-fibrous dysplasia.
Symptomatology
Symptoms of Lerish syndrome are as follows:
- The occurrence of parietal calcifications and blood clots.
- Excessive thickening of the walls of the aorta.
- The presence of severe soreness of the calf and gluteal muscles, which increases during walking or running.
- The presence of intermittent claudication.
- Pathology of distal blood flow.
- A feeling of chilliness in the limbs, and this is rarely explained by a real decrease in temperature in the environment.
- Increasing erectile dysfunction, sooner or later leading to complete impotence. It is worth noting that the treatment of sexual impotence in this situation is completely useless. Symptoms of Leriche syndrome are rather unpleasant.
- The presence of cyanosis of the skin of the legs above the knee.
- Decreased muscle mass.
- The temperature of the affected limb is usually reduced by one to two degrees.
- The presence of ulcerations on the skin, which in the last stage can lead to necrotization. In this case, the lesion affects mainly the feet.
- Inability to determine pulsation of the femoral artery.
- The presence of systolic murmur in the groin area.
Diagnosis of Lerish syndrome
The first thing to do is, of course, to visit a doctor, who will have to conduct a thorough examination of the patient and collect a detailed history. Auscultation and palpation are also required. Instrumental research methods include the following procedures:
- Ultrasonic flowmetry.
- Doppler imaging.
- The implementation of rheovasography, in which an assessment is made of the general condition of the heart and blood vessels, and in addition, their tone.
- Plethysmography - registration of changes in the pelvic organs, which are associated with the dynamics of the process of filling the blood vessels.
- Sphygmography is a study of the movement of the aortic wall that occurs during each heart beat.
- Determination of muscle blood flow.
- Calculation of the ankle index. As part of the index calculation, foot pressure is divided by the same radial artery parameter. The normal value in this case is the norm: from 1.1 to 1.2. In the event that the value is in the region of 0.8, then the patient may appear signs of lameness. If the parameter is 0.3, then this will indicate the beginning of some ulcerative and necrotic changes.
- Angiography. Depending on the type, this type of diagnosis can be radionuclide, subtraction, digital and radiopaque.
- Implementation of transluminal puncture aortography, which is designed to detect the extent and localization of lesions.
Diagnosis of Lerish syndrome including should be differential.
Perform differential diagnostics
The syndrome can for a long time be masked by some other pathologies that have different clinical manifestations, for example, obliterating endarteritis. Against the background of this deviation, the following symptoms will be observed:
- The most likely lesion area is usually the vessels of the lower leg.
- Observation of pulsation of the femoral arteries.
- Lack of characteristic systolic murmur.
- Most patients are under the age of thirty.
Another such disease is lumbosacral radiculitis, in which the following symptoms are observed:
- The severity of symptoms is not related to movement.
- Preservation of pulsation of the main arteries.
- Localization of pain on the outer thighs.
- Lack of vascular noise.
Next, consider the treatment of Leriche syndrome.
The importance of timely treatment
Most aortic-iliac diseases, and this syndrome is no exception, can be cured in several ways. But, unfortunately, patients do not always come to the doctor on time and prefer to suppress pain through analgesics to the last. As a result, it often turns out that carrying out sparing conservative treatment does not work, and the patient's condition only worsens. The need for surgery in this situation remains the only option. But in the event that a person himself will notice the first signs of a problem, then the choice of the doctor will be much wider.
It is important to start treating Leriche syndrome in a timely manner.
What should be the conservative treatment?
As part of conservative treatment, the patient is required to comply with the following requirements:
- The patient completely abandons smoking habits.
- Controlling blood glucose levels.
- Maintaining blood pressure in a normal state. Thus, the pressure should not be higher than 140/90 millimeters of mercury.
- Lowering bad cholesterol to a value of 2.59 mol per liter. For this, treatment with statin drugs is carried out.
- Daily walks. It is very important that the body breathes fresh air.
Compliance with the above recommendations will reduce the impact of risk factors.
Conducting drug therapy
As part of the medical treatment of atherosclerosis with Lerish’s syndrome, the following two drugs are usually used:
- Trental is considered effective in thirty percent of cases. It should be taken strictly three times a day.
- Phosphodiesterase inhibitors in the form of the drug "Cilostazolum". This medication is contraindicated in those patients who have congestive heart failure. Its effectiveness is much higher than that of Trental, but a medication alone will not be enough.
It should be borne in mind that both of these drugs are not without side effects in the form of nausea, diarrhea or headaches, in this regard they should be used only under medical supervision.
Surgical treatment of Lerish’s syndrome is also performed.
Surgical intervention
Reconstructive surgery can help patients suffering from severe aortic obstruction. There are quite a few options. The doctor should first of all evaluate the volume of vascular wall lesions along with the nature of blood flow, the severity of side symptoms and many other various factors. Only after this, the doctor should offer the patient an operation. There are four main types of operations:
- Carrying out an endarterectomy, which consists in removing the substrate that causes blockage. The procedure is carried out through a small incision in the artery.
- Performing prosthetics, which consists in replacing the affected area of the vessel with a healthy one. He is usually taken from another limb. In addition, they sometimes use a synthetic analogue.
- Bypass surgery is to create a way to restore the circulation of normal blood flow bypassing the affected area. In the event that the problem exists in both limbs, the surgeon sews a special bifurcation prosthesis, which is commonly called "pants".
- Performing percutaneous transluminal angioplasty, and in addition, stenting. Such operations are gentle and minimally invasive methods of surgical intervention, in which a specialist surgeon eliminates clogging of the vessel thanks to a special probe that is inserted through the coronary artery. After that, a special supporting frame is installed.
What to do after surgery for Lerish’s syndrome?
Postoperative period and possible complications
The first few hours of the postoperative period are especially difficult in terms of prosthetic thrombosis and hemodynamic disturbances. The most important task for the anesthesiologist and doctor is to maintain stable hemodynamics after surgery, since a patient's pressure drop below 100 millimeters can cause shunt thrombosis. In this regard, as a rule, all failures in these operations occur in the first minutes and hours after their completion.
The percentage of late thrombosis on the background of Leriche syndrome is small. As practice shows, after a long operation and large blood loss, when the shunt is included in the bloodstream, a drop in pressure may occur. This period on the part of the anesthetist requires the necessary techniques. For example, vasoconstrictors, such as ephedrine or epinephrine, are introduced to increase peripheral resistance. But these drugs significantly complicate the work of the heart, leading to even greater depletion of the contractile functions of the myocardium. In this regard, such medications should be prescribed in minimal doses.
Sometimes collapsed states with a rapid drop in pressure can be explained by the depletion of the adrenal system, and in addition, adrenal insufficiency. Therefore, before and during surgery, the patient is prescribed "Cortisone", which must be taken at 75 milligrams two days before the operation and within three days after it. Instead of vasoconstrictor drugs against the background of a drop in pressure within the postoperative period, it is rational to introduce fast-acting heart drugs, such as, for example, Strofantin.
Another permanent complication in the postoperative period with aortic atherosclerosis (Leriche syndrome) is the presence of severe intestinal paresis due to trauma to the nervous system and the inevitable appearance of a retroperitoneal hematoma. In order to combat this complication, it is required to provide the patient with the introduction of a sufficient amount of proteins and, within three days after the operation, carry out a set of various measures in the form of limiting nutrition through the mouth and prescribing pituitrin. Also, patients require intravenous administration of a hypertonic solution of sodium chloride along with gastric lavage and siphon enemas.
Some experts recommend introducing a thin catheter through the patient’s nose before completing the operation, which is then carried into the intestine. By means of a catheter, intestinal contents are evacuated in the postoperative period. In order to prevent paresis during the operation, novocaine blockade of the mesentery of the intestine and retroperitoneal space is performed.
Alternative methods of treating Lerish syndrome
Folk remedies categorically do not recommend treating this disease, so as not to aggravate the situation. But to normalize overall well-being, it is necessary to lead a healthy lifestyle, stop smoking, spend more time in the fresh air and be sure to eat right.
We examined the clinic, diagnosis and treatment of atherosclerosis of the aorta and Lerish’s syndrome.