Author + information
- Received April 24, 2009
- Accepted June 3, 2009
- Published online November 3, 2009.
A 62-year-old man with a history of hyperlipidemia and prolonged smoking presented for evaluation of impotence and recent exertional thigh and buttock claudication after starting an exercise regimen. His examination demonstrated nonpalpable right and weak left lower extremity pulses. Doppler ultrasonography (A)revealed low velocity flow and loss of normal triphasic waveforms in the femoral arterial vasculature bilaterally. Three-dimensional volume-rendered reconstructions (B)from computed tomography angiography showed abdominal aortic occlusion below the origin of renal arteries (white arrowhead)and collateral circulation from the lower intercostals to the common femoral arteries (CFAs). These collaterals bilaterally fill the deep iliac circumflex arteries (red arrows)and inferior epigastric arteries (blue arrows). The arc of Riolan (white arrows), a central collateral pathway between the superior mesenteric artery and inferior mesenteric artery vascular distributions, is clearly opacified. These findings are classical for Leriche syndrome. The patient refused aortobifemoral bypass grafting.
- Received April 24, 2009.
- Accepted June 3, 2009.
- American College of Cardiology Foundation