965 - Leriche Syndrome: An Unlikely Cause of Lower Back and Hip Pain

Aorto-iliac Occlusive Disease

Case Description:

A 73-year-old male with a history of coronary artery disease, hyperlipidemia, and other comorbidities, reported lumbosacral back and right hip pain that had gradually worsened over several years. Initial treatments, including epidural steroid injections, physical therapy, and other various hip and spine interventions, provided only partial relief, with persistent pain during ambulation. Despite these interventions, and given his extensive cardiovascular history, further evaluation was pursued. Imaging revealed significant atherosclerotic calcifications in the abdominal aorta and bilateral iliac arteries. Although his initial ABIs were within normal limits, an aortoiliac duplex and exercise PVR uncovered arterial insufficiency, particularly in the right lower extremity. The patient subsequently underwent a right common iliac artery stent graft placement, which led to the resolution of his symptoms and normalization of his ankle-brachial index.

Discussions:

Leriche Syndrome poses diagnostic challenges due to its ambiguous presentation, often mimicking musculoskeletal conditions such as radiculopathy, piriformis syndrome, or spinal stenosis. The classic symptoms, while indicative, are not exclusive to the condition, complicating the diagnostic process. This case underscores the importance of a comprehensive approach, including detailed patient history, physical examination, and advanced imaging techniques, in distinguishing Leriche Syndrome from other pathologies. Early and accurate diagnosis is crucial, as misdiagnosis can result in inappropriate treatments, prolonged patient discomfort, and decreased functionality.

Conclusions:

Leriche Syndrome, or aorto-iliac occlusive disease (AIOD), is a progressive arterial condition marked by atherosclerosis in the distal abdominal aorta, iliac arteries, and femoropopliteal vessels. It classically presents with a triad of decreased peripheral pulses, buttock and thigh claudication, and erectile dysfunction. Clinical suspicion of such diagnosis would require evaluation with ankle-brachial indices (ABI), exercise pulse-volume recording (PVR), and treatment with vascular stenting. A high index of suspicion is essential, particularly in patients with significant cardiovascular risk factors who present with leg pain and diminished pulses.