Serdar DEMİRGAN, Abdullah Tolga ŞİTİLCİ, Sezen SOLAK, Mehmet Salih SEVDİ, Kerem ERKALP, Emin KÖSE

Leriche sendromu

aortada, sıklıkla renal arterlerin distalinde trombotik oklüzyonla karakterize bir hastalıktır. Bu sendromun klasik semptomları; alt ekstremitede egzersizle ortaya çıkan ağrı (klodikasyon), femoral nabızların palpe edilememesi ve erkek hastalarda impotanstır. Dolaşım yetersizliğine bağlı klodikasyon ile nörojen kaynaklı klodikasyonun ayırıcı tanısı zordur. Ayırıcı tanı yapılmasında anamnez, fizik muayene ve görüntüleme yöntemleri önemli yer tutar. Fizik muayenede bilateral femoral nabızların palpe edilememesi Leriche sendromunu akla getirmelidir. Leriche sendromlu olgularda renkli Doppler ultrasonografi ile, her iki iliyak arterde de akım olmadığı gösterilebilir. Bu hastalarda bilgisayarlı tomografi anjiyografi ile aortadaki trombotik tıkanıklık doğrulanmalıdır. Sunduğumuz bu vaka klodikasyon şikayetiyle hastaneye başvurmuş ve lomber disk hernisi tanısı konulmuş bir Leriche sendorumu vakasıdır. Ayırıcı tanıda vasküler patolojiler düşünülmemesi nedeniyle tedavisinde geçikilmiş ve mortaliteyle sonuçlanmış olması nedeniyle önem taşımaktadır. Bacak ağrısı şikayetiyle hastaneye başvuran hastalarda vasküler patolojiler ayırıcı tanıda düşünülmeli ve klinisyenler tanıya giden yolda öncelikle detaylı anemnez ve kapsamlı bir fizik muayeneye güvenmelidirler.

Leriche syndrome

Leriche syndrome is a disease characterized by thrombotic occlusion in the aorta, frequently in the distal renal artery. Classic symptoms of this syndrome include pain in the lower extremities emerging during activity (claudication), impalpability of femoral pulses, and impotency in male patients. Definitive diagnosis of claudication due to insufficient circulation as well as claudication that is neurogenic in origin, is difficult. Medical history, physical examination, and monitoring methods are important for definitive diagnosis. Impalpability of bilateral femoral pulses in physical examination may be sign of Leriche syndrome. Color Doppler ultrasonography can be used to demonstrate that there is no circulation in the iliac arteries in cases of Leriche syndrome. In these patients, thrombotic occlusion of the aorta is confirmed by computed tomography angiography. Presently described is a case of Leriche syndrome in which the patient presented at hospital with complaint of claudication and was diagnosed with lumbar disc herniation. Since vascular pathologies were not considered in differential diagnosis, treatment was delayed and it resulted in mortality; for this reason it is important. When patients come to hospital with complaints of leg pain, clinicians should consider vascular pathologies before reaching definitive diagnosis, using detailed patient history and comprehensive physical examination.

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Leriche R, Morel A. The Syndrome of Thrombotic Oblitera- tion of the Aortic Bifurcation. Ann Surg 1948;127(2):193- 206.
Jian W, Tajima H, Murata S, Abe Y, Hakozaki K, Kumazaki T, et al. Renal artery stenosis in a patient with Leriche syndro- me: brachial artery access for stent placement. Radiat Med 2004;22(1):49-51.
Yoon do H, Cho H, Seol SJ, Kim T. Right calf claudication revealing leriche syndrome presenting as right sciatic neu- ropathy. Ann Rehabil Med 2014;38(1):132-7.
Akhaddar A, Eljebbouri B, Saouab R, Boucetta M. Acu- te paraplegia revealing Leriche syndrome. Intern Med 2012;51(8):981-2.
Fernandez BB Jr. A rational approach to diagnosis and treatment of intermittent claudication. Am J Med Sci 2002;323(5):244-51.
Wang YC, Chiu YS, Yeh CH. Leriche's syndrome presenting as sciatica. Ann Vasc Surg 2010;24(5):694.e1-3.
Wilson CB. Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 3: Intermittent claudication. J Neurosurg 1969;31(5):499- 506.
Epstein NE, Maldonado VC, Cusick JF. Symptomatic lumbar spinal stenosis. Surg Neurol 1998;50:3-10..
Seyithanoglu MH, Gundag M, Dogan K, Kıtıs S, Aydın T, Peru C. Leriche syndrome with lumbar disc hernia: First case report in literature. J Neurol Sci 2011;28:641-5.
Finsterer J, Stöllberger C, Mölzer G, Fischer H. A vascular ca- use of painful lumbar transverse syndrome. J Spinal Cord Med 2009;32(5):587-90.
Manson NA, McKeon MD, Abraham EP. Transforaminal epidural steroid injections prevent the need for surgery in patients with sciatica secondary to lumbar disc hernia- tion: a retrospective case series. Can J Surg 2013;56(2):89- 96.
Awad JN, Moskovich R. Lumbar disc herniations: surgi- cal versus nonsurgical treatment. Clin Orthop Relat Res 2006;443:183-97.