Leriche Syndrome after Visceral Aortic Revascularization – What Now?

INTRODUCTION: Thoraco-bifemoral bypass (TBF) is an alternative to aorto-bifemoral bypass (ABF) or axilobifemoral bypass for severe aortoiliac occlusive disease. TBF may be particularly useful in select patients with concurrent visceral aortic branch vessel disease, infrarenal aortic occlusions, or after failed ABF. We describe a clinical case of a symptomatic Leriche syndrome in the presence of concurrent visceral aortic branch vessel disease. CASE REPORT: A 57-year-old male patient with a history of Leriche syndrome and acute thrombosis of the right renal artery with acute kidney injury underwent parallel grafting of the celiac trunk, superior mesenteric artery, and right renal artery 12 months before the current episode. He developed intermittent claudication for very short distances (around 5 meters), with significant limitations for activities of daily living and an inability to carry out his work activity. We decided to perform a TBF bypass through a left thoracotomy, which was uneventful. The patient is asymptomatic and has palpable pedal pulses at the 24-month follow-up. Postoperative computed tomography angiography revealed visceral aorta branches and TBF bypass patency. CONCLUSION: TBF bypass can be performed with good outcomes for patients with severe AIOD, especially if concomitant visceral/infrainguinal reconstruction is warranted. These results support a continued role for TFB in selected patients.