Axillobifemoral bypass due to severe case of Leriche syndrome

Abstract

Introduction: Leriche syndrome, is a form of central artery disease involving the blockage of the ab­dominal aorta, as it transitions into the common iliac arteries. Materials and methods: A 76 year old female patient had complaints of severe pain and cramping in her lower limbs after walking distance of 50 meters, since at least two months before arriving to the hospital. The patient`s limbs were cold and livid. After CT assisted angiography total occlusion of the abdominal aorta was concluded, just below the right renal artery, as well as critical stenosis of the ce­liac trunk. Multiple calcifications and occlusions continue down the arterial branch until the distal common femoral arteries. After discussing the case, the decision was made for an axillobifemoral by­pass to be performed. The operation was performed with a total of four approaches - two to the com­mon femoral artery (left and right), one to the left axillary artery and one skin incision just above the ninth thoracic rib on the left side. A synthetic graft was used, which was anastomosed with 5/0 prolen sutures to the axillary artery. The graft was driven under the skin all the way to the left femoral ar­tery. A crossover bypass was performed from the right femoral artery. Results: After the operation the patient had Doppler pulsation signals on both sides, stable haemody­namics, colour and limb temperature were normal. Stitches were removed on the fourteenth day after the operation and anticoagulant treatment was prescribed. The limbs were well supplied with blood on the first and second control examination. Conclusions: Leriche syndrome is a serious conditions, which often times requires a special type of treatment, especially in elderly patients. In such cases rare operations must be performed to ensure blood flow recovery to the patient`s lower limbs.