Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
BMC Cardiovasc Disord. 2021 Sep 26;21(1):465. doi: 10.1186/s12872-021-02272-3.
Aortoiliac occlusion disease, also called Leriche syndrome, is characterized by atherothrombotic obliteration of the aortic bifurcation and bilateral common iliac arteries; typically, it has a chronic presentation. Pulmonary embolism is more related to venous thromboembolism rather than arterial thromboembolic events. Therefore, cases of simultaneous acute Leriche syndrome and pulmonary embolism are rare. Existing intracardiac right-to-left shunt were detected in most previous cases. Herein, we present the first likely documented case wherein acute Leriche syndrome and pulmonary embolism occurred simultaneously without a patent foramen ovale.
A 58-year-old man with hyperlipidemia and coronary artery disease presented with a 4-h history of bilateral lower limb numbness. He was a heavy smoker with a history of stroke. Computed tomography angiography revealed pulmonary embolism and aortoiliac artery occlusion. Although a massive thrombus straddled the bilateral pulmonary arteries, orthopnea was his only presentation, without right ventricle failure. Cyanosis of the affected limbs was noted, and muscle strength in both limbs had regressed to grade 1. Owing to acute limb ischemia, he underwent an emergency operation to salvage the limbs. On postoperative day 5, the general condition of both the legs improved; the muscle strength improved to grade 4. He was then transferred to the general ward and enoxaparin was continued. Computed tomography angiography was repeated to evaluate the pulmonary embolism on postoperative day 8; the thrombus remained lodged in the bilateral main pulmonary arteries. Owing to persistent orthopnea and chest tightness with intermittent tachycardia, he underwent a staged operation for the pulmonary embolism on postoperative day 13. During the surgery, intraoperative transesophageal echocardiography showed no patent foramen ovale or an existing right-to-left shunt. Postoperatively, he was closely monitored in the intensive care unit for 3 days and then transferred to the general ward for 10 days. A final computed tomography angiography performed on postoperative day 18 revealed thrombus resolution. He was then discharged on postoperative day 30 without any in-hospital complications.
We present a case that might be the first documented report of acute Leriche syndrome co-occurring with pulmonary embolism without an existing patent foramen ovale.
主髂动脉闭塞性疾病，又称 Leriche 综合征，其特征为主动脉分叉和双侧髂总动脉的动脉粥样硬化性血栓闭塞，通常表现为慢性过程。肺栓塞与静脉血栓栓塞的关系更为密切，而非动脉血栓栓塞事件。因此，同时发生急性 Leriche 综合征和肺栓塞的情况较为少见。既往大多数病例中发现存在心内右向左分流。在此，我们报告首例可能明确记录的无卵圆孔未闭同时发生急性 Leriche 综合征和肺栓塞的病例。
一名 58 岁男性，有高血脂和冠心病病史，以双下肢麻木 4 小时为主诉就诊。他是一名重度吸烟者，有卒中病史。计算机断层血管造影术显示肺栓塞和主髂动脉闭塞。尽管大量血栓跨越双侧肺动脉，但他仅表现为端坐呼吸，无右心衰竭。受累肢体发绀，双下肢肌力均减退至 1 级。由于急性肢体缺血，他接受了紧急手术以挽救肢体。术后第 5 天，双腿一般情况改善，肌力恢复至 4 级。随后转入普通病房，继续使用依诺肝素。术后第 8 天行计算机断层血管造影术评估肺栓塞，双侧主肺动脉仍有血栓。由于持续端坐呼吸和间歇性心动过速，术后第 13 天行肺栓塞分期手术。手术期间，术中经食管超声心动图检查未发现卵圆孔未闭或现有的右向左分流。术后在重症监护病房密切监测 3 天，然后转入普通病房 10 天。术后第 18 天行最终计算机断层血管造影术显示血栓溶解。术后第 30 天无院内并发症出院。
我们报告了一例可能是首例无卵圆孔未闭同时发生急性 Leriche 综合征和肺栓塞的病例。
