C28. Chronic Limb Threatening Ischemia in Patient With Aortoiliac Occlusive Disease (Leriche Syndrome) and Pulmonary Hypertension

Abstract

Abstract Background Chronic limb-threatening ischemia (CLTI) is a manifestation of peripheral arterial disease (PAD) which is characterized by stenosis or occlusion of peripheral arteries causing impaired perfusion to the extremities, especially during rest and chronic progresses, which are associated with decreased quality of life and increased morbidity and mortality. Case Description A 51-year-old man complained of wound on both legs and pain during light activity. Risk factor is smoking for 30 years. History of primary pulmonary hypertension since 30 years. Physical examination revealed decreased pulsation from femoral artery to dorsalis pedis arteries in both leg. Echocardiography with RA and RV dilatation, D-shaped LV during systolic, mild TR and normal LV systolic function. Dupplex ultrasound and MSCT scan pulmonary-abdominal angiography shows thrombus in the abdominal aorta causing occlusion of blood flow distally. There is a comorbid pulmonary hypertension which causes right heart failure with symptoms of dyspnea. This patient is at high risk of undergoing revascularization surgery, so that in severe comorbid conditions an extraanatomical bypass with axillobifemoral bypass graft is considered. Discussion Atherosclerosis that occurs in the abdominal aorta, iliac artery, and femoropopliteal artery is called aortoiliac occlusive disease (AIOD). This condition when symptomatic is known as Leriche syndrome with a triad of symptoms of claudication, impotence, and reduced or no palpable pulsation of the femoral artery. Medical management include antiplatelet, statin, analgetic, and therapy according to risk factors. The main purpose is revascularization by surgery or endovascular which aims to improve blood flow to the distal artery.