Circulación colateral en enfermedad oclusiva aórtica y visceral. Síndrome de Leriche Translated title: Collateral pathways on aortoiliac and mesenteric occlusive disease. Leriche syndrome

A 58-year-old man was admitted for coronary angiography after several months of worsening angina. After two failed femoral catheterization attempts due to guide-wire obstruction, access was achieved through the right brachial artery. Catheterization revealed severe three-vessel coronary artery disease. An aortogram was performed revealing a complete occlusion of the aorta inferior to the renal arteries. A computed tomography angiography with runoff demonstrated significant collateral circulation with reconstitution of the distal femoral arteries. (see image 1)On further history, the patient noted bilateral calf and buttock claudication, erectile dysfunction and a 40-pack year smoking history. Despite complete aortic occlusion, the patient had 1+ palpable posterior tibial and dorsalis pedis pulses due to extensive collateralization. (see image 2) Leriche syndrome is the triad of claudication, impotence and decreased pulses due to aortoiliac occlusion.1 Risk factors include hyperlipidemia, hypertension, diabetes mellitus and smoking. The Ankle Brachial Index is a non-invasive, inexpensive and reliable method to screen patients.2 Treatment is aimed at relieving the symptoms related to aortic occlusion as well as the prevention of proximal propagation of thrombus. Complete aortic occlusion is treated with open bypass surgery although new endoscopic techniques are on the horizon.3 Our patient had a successful three vessel CABG followed 2 months later by aortofemoral bypass. His claudication completely resolved 3 weeks postoperatively.

The development of collateral pathways for arterial blood flow is common in the presence of atherosclerotic occlusive disease of the abdominal aorta and iliac arteries. The collateral pathways are divided into systemic-systemic and systemic-visceral pathways. MDCT is commonly used to evaluate aortic stenosis and the resulting collateral pathways.

In patients with aortoiliac occlusion, the internal thoracic artery-inferior epigastric artery (ITA-IEA) collateral is one of the collaterals supplying blood flow to the lower extremity, and the interruption of this collateral may cause severe leg ischemia. The aim of this study was to evaluate by color duplex ultrasonography scans the ITA-IEA pathway and its significance as a collateral in providing lower-extremity perfusion in aortoiliac occlusive disease.