50 years old man complaining of bilateral buttock

 

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Doctor's Information

Name :  Morteza
Family :Sanei Taheri
Affiliation : ----------------
Academic Degree: ----------------
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  Morteza Babaii

 

Patient's Information

Gender :  Male
Age :  50

 

Case Section

Cardiovascular

 

Clinical Summary

50 years old man complaining of bilateral buttock claudication and impotence.

 

 

Imaging Procedures and Findings

Images from MRA show cut off at abdominal Aorta just distal to origin of renal arteries and run off at Iliac arteries. Vessels of lower extremities are completely normal.

 

Discussion

The distal abdominal aorta and the iliac arteries are common sites of involvement with atherosclerosis. Aortoiliac occlusive disease occurs in a relatively younger group of patients (aged in their mid-50s), compared with patients with more femoropopliteal disease. It also differs from disease of the femoral-popliteal-tibial segment since it is rarely limb-threatening. Symptoms typically consist of bilateral thigh or buttock claudication and fatigue. Men report diminished penile tumescence, and there may later be complete failure of erectile function. These symptoms constitute Leriche's syndrome. Rest pain is unusual with isolated aortoiliac disease. Femoral pulses are usually diminished or absent. There are usually no stigmata of ischemia unless distal disease coexists. A small group of patients report a prolonged history of thigh and buttock claudication that has recently become more severe. It is likely that this group has underlying significant aortoiliac disease that has suddenly progressed to acute occlusion of the terminal aorta. Others may present with "trash foot," representing microembolization into the distal vascular bed. Noninvasive tests such as pulse volume recordings of the lower extremity with estimation or the thigh-brachial pressure index may be suggestive of aortoiliac disease. Definitive diagnosis, however, can only be established by arteriography. This further provides important information regarding distal arterial run-off (particularly the profunda femoris) and demonstrates pelvic collaterals that may be important in maintaining lower limb viability. It must be emphasized, however, that patients should be subjected to angiographyonly if their symptoms warrant surgical intervention.

 

Final Diagnosis

Leriche syndrome

 

References

Schwartz's Principles of Surgery, Eighth Edition

 

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