Horseshoe Kidney in a Patient with Leriche Syndrome

Horseshoe kidney (HSK) is one of the most common congenital renal fusion anomalies. Difficulties are encountered during surgery of aortic diseases associated with this anomaly. A 47-year male presented to the Outpatient Clinic with one-year history of intermittent claudication in 20 meters. He was diagnosed with Leriche syndrome and horseshoe kidney (HSK). The patient underwent aorto-bifemoral bypass surgery via transperitoneal approach. The proximal anastomosis was completed in an end-to-side fashion. The bifurcated graft was positioned posteriorly to the isthmus; and distal anastomoses were performed onto the common femoral arteries. He was discharged from the hospital on the eighth postoperative day without any complications. Key Words: Abdominal aorta, Surgery, Horseshoe kidney, Leriche syndrome.

Outcome Analysis and Risk Factors for Perioperative Myocardial Ischemia After Elective Aortic Surgery

BACKGROUND

Perioperative myocardial ischemia (PMI) after non-cardiac surgery remains a serious postoperative complication. This study analyzed the risk factors and outcomes of patients who suffered from PMI after elective aortic surgery.

PATIENTS AND METHODS

Data from 863 patients who underwent elective aortic surgery for aneurysms or Leriche syndrome were retrospectively analysed with regard to PMI. The diagnosis of PMI was based on a positive serum troponin diagnostic test. According to the clinical signs and symptoms, the patients with PMI were divided into two groups: symptomatic and asymptomatic patients. Comorbidities, preoperative medication, intraoperative parameters, postoperative complications, mortality, length of intensive care stay and hospitalisation, as well as the long-term follow-up, were compared in a matched-pair analysis (1:3) with patients without PMI. Logistic regression analyses were performed to identify independent risk factors for PMI.

RESULTS

Thirty-two patients with PMI were identified. Cardiac comorbidities (previous myocardial ischemia, P = 0.0099; left ventricular systolic dysfunction, P = 0.0429), ASA score ≥III (P = 0.0114) and preoperative elevated creatinine (P = 0.0194) were more common in patients who suffered PMI. The regression analysis confirmed that peripheral artery disease and prolonged operative duration >180 min are significant predictors of PMI. Surgical complications (wound healing deficit, P = 0.0027; rate of secondary interventions during primary admission, P = 0.0057) and medical complications (pneumonia, P = 0.0002; renal dysfunction, P = 0.0041) were more common in patients with PMI compared to the control group. Patients who suffered PMI remained in intensive care for a significantly longer period (P = 0.0001) and were also hospitalized for longer (P = 0.0001) than the control group. The long-term survival of patients who suffered PMI after aortic surgery was significantly worse than the control group (P < 0.0001, median 53 vs. 84 months), independent of clinical ischemia-associated symptoms.

CONCLUSIONS

PMI after aortic surgery not only affects long-term survival, but also correlates with worsening of surgical outcome. Thus, meticulous preoperative risk stratification is required for high-risk patients, together with routine postoperative monitoring of troponin levels after aortic surgery.

CT angiography and 3D imaging in aortoiliac occlusive disease: collateral pathways in Leriche syndrome

Collateral pathways in aortoiliac occlusive disease are essential for arterial blood flow to the abdomen, pelvis, and lower extremities. These pathways can be broadly divided into systemic-systemic, visceral-visceral, and systemic-visceral collateral networks. MDCT angiography is the most commonly used modality for the diagnostic evaluation of patients with aortoiliac occlusive disease, allowing excellent evaluation of stenotic arterial segments, as well as beautifully illustrating resulting collateral pathways (particularly when utilizing 3D reconstruction techniques). This article seeks to familiarize radiologists with the most common patterns of aortoiliac occlusion and associated arterial collateral pathways utilizing CT angiography.

Successful endovascular treatment for high take off aorto-iliac occlusive disease

A 73-year-old man with a history of intermittent claudication for the previous six years visited our hospital. His ankle-brachial index (ABI) was very low on both sides, and computed tomography (CT) indicated bilateral aorto-iliac occlusive disease (AIOD). As he refused to undergo open surgery, endovascular treatment (EVT) was administered. After the first and second EVT sessions, the intermittent claudication improved completely. In addition, the ABI normalized (right: 1.01, left: 0.99), and CT demonstrated full expansion of the stents. His post-EVT course was uneventful for 18 months. The use of EVT to treat AIOD is technically feasible and may serve as a potential treatment option for patients with an inoperable condition.

Covered endovascular reconstruction of aortic bifurcation (CERAB) technique: a new approach in treating extensive aortoiliac occlusive disease

Endovascular treatment of occlusive disease of the aortic bifurcation is challenging. We developed the Covered Endovascular Reconstruction of Aortic Bifurcation or CERAB-technique, as a new approach for extensive and/or recurrent aortoiliac occlusive disease using three covered balloon expandable stents to reconstruct the aortic bifurcation. This configuration provides the ability to deal with TransAtlantic Inter-Society Consensus (TASC II) C and D lesions, simulating a neo-bifurcation or flow divider in combination with the benefits of covered stents. The intervention can be performed percutaneously or as a hybrid procedure. Initial results are encouraging and further studies are indicated.

Primary aortoduodenal fistula in combination with aortoiliac occlusive disease: report of a rare case

Most of the cases of aortoenteric fistula are due to aneurysm of the aorta, although infection, tumor, radiotherapy, gastric ulcers and foreign body ingestion have also been described in the literature. We report the case of a 62-year-old woman presenting with massive gastrointestinal bleeding with hematemesis and melaena. This case is unique in that the primary aortoduodenal (PADF) fistula formed as a result of complex atherosclerotic disease of the abdominal aorta and both iliacal arteries, also known as Leriche's syndrome, and not primarily due to an aneurysm. We will give a brief summary of the difficulties and challenges which the surgeon faced during the operation and a surprisingly uneventful postoperative course.

Atypical electrolyte kinetics during an emergency dialysis session in a patient with Leriche syndrome

A hemodialysis patient suffered from circulation failure due to a low output syndrome caused by a hyperkalemia (9.9 micromol/l) with typical ecg signs. An emergency hemodialysis was started. After 2 h ecg signs of hypokalemia (2.1 micromol/l) were detectable. Hemodialysis was stopped. 2 h later, serum potassium rose to 6.2 micromol/l. An obturation of the aorta and the inferior caval vein with perfusion through collateral vessels of the lower body side was obvious, resulting into a faster electrolyte correction in the upper and a delayed correction in the lower body side with a rebound in the upper compartment. Dialysis time and dialysate potassium (4.0 micromol/l) were increased. Furthermore no potassium problems occurred.

Abnormal collateral arterial systems in Takayasu's arteritis and Leriche's syndrome evaluated by whole body acquisition using multislice computed tomography

Takayasu's arteritis causes various arterial changes, including wall thickening, occlusion, aneurysm, and calcification. Similarly, Leriche's syndrome causes occlusion of the abdominal aorta or iliac arteries accompanied by ischemic symptoms of the distal lower extremities. Both diseases are potentially associated with the development of unexpected collateral arteries throughout the body. We evaluated whole body arteries in subjects with Takayasu's arteritis and Leriche's syndrome using 16-slice multislice CT and concluded that it was a useful tool to detect unexpected collateral arterial systems in Takayasu's arteritis or Leriche's syndrome in a non-invasive fashion.

Endovascular treatment of steno-occlusions of the infrarenal abdominal aorta

PURPOSE

Our aim is to report our experience in the endovascular treatment of steno-occlusions of the infrarenal abdominal aorta.

MATERIALS AND METHODS

We selected 19 patients (mean age 66.3 years, range 45-80): five with complete occlusion of the infrarenal aorta and both common iliac arteries (CIAs), four of which were associated with occlusion of the external iliac arteries (EIAs); three with complete occlusion and three with severe stenosis of the distal aorta with occlusion or stenosis of the CIAs and EIAs; and eight with focal severe stenosis of the infrarenal aorta. All patients were treated with direct stenting.

RESULTS

Immediate technical success was 94.7% (18/19 cases). We observed two cases of distal embolism treated with thrombolysis, one case of mild renal failure and one case of transient angina abdominis. During the follow-up (mean 19.6 months; range 6-48), 2/18 (11.1%) occlusions of an iliac stent occurred 1 and 3 months after the procedure (treated with local intra-arterial thrombolysis). The primary patency rate was 88.8% and the secondary patency rate was 100%.

CONCLUSIONS

Direct stenting is a feasible and safe option for the treatment of infrarenal abdominal aortic steno-occlusions, especially in patients at high surgical risk, with good early and late clinical results.

Digital-image analysis of the angiographic patterns of the popliteal artery in patients with aorto-iliac occlusive disease (Leriche syndrome)

Angiographic patterns of the popliteal artery are of great clinical relevance in vascular surgery below the knee. Using radiological, digital and statistical methods the variants and Luminal diameters of the popliteal artery branching in 46 men and 30 women with Lerich syndrome were studied. Statistical analysis did not reveal any gender or syntopic dimorphisms (P > or = 0.05). In subtype IA (87.5%) the anterior tibial artery and the short type of posterior tibioperoneal trunk were found. In subtype IB (2.63%) an arterial trifurcation was observed. In subtype IC (1.97%) the posterior tibial artery and the short type of anterior tibioperoneal trunk were seen. In two subtypes: IIA-1 (1.32%) and IIA-2 (0.66%) the anterior tibial artery and the long type of posterior tibioperoneal trunk were found. In subtype II B (5.92%) the long type of anterior tibioperoneal trunk and the posterior tibial artery were observed. The symmetry of the left and right poptiteal patterns was seen in two most frequent subtypes: I A (r1 = 0.80) and II B (r2 = 0.83). Either the anterior or posterior tibial artery had a smaller diameter than the coexisting tibioperoneal trunk (P<0.01). In a trifurcation the luminal diameters formed a decreasing sequence of the following arteries: anterior tibial, posterior tibial and peroneal. The angiometric analysis of luminal diameters showed the predominant vessel in each subtype: anterior tibioperoneal trunk (IC, IIB), posterior tibioperoneal trunk (IA, IIA-1, IIA-2) and anterior tibial artery (IB).

An angiographic study of the anterior tibial artery in patients with aortoiliac occlusive disease

The anterior tibial artery is of great clinical relevance to vascular infrapopliteal surgery. The sources (origins), length and luminal diameter of the anterior tibial artery in 46 men and 30 women with Lerich syndrome were studied by means of radiological and digital methods. The results obtained were described by two-way analysis of variance (Multi-group ANOVA) for unpaired data--the means for six subtypes with regard to sex and side of the body, using the STATISTICA 5.5 program. The anterior tibial artery occurred most frequently (92.11%) as a terminal branch of the popliteal artery in its normal (IA: 87.5%, IB: 2.63%) and high (IIA 1: 1.32%, IIA 2: 0.66%) division. In the remainder (7.89%), the anterior tibial artery arose from both the anterior tibioperoneal trunks (IC: 1.97%, IIB: 5.92%). The statistical analysis of the sources of the anterior tibial artery did not show gender differences. Symmetry of the left and right popliteal patterns was observed in the two most frequent subtypes: IA (r1 = 0.80) and IIB (r2 = 0.83). The anterior tibial artery was the longest (p = 0.02 for men, p = 0.04 for women) in subtype IIA 2. The greatest diameter of the anterior tibial artery was characteristic for a trifurcation (IB) and the smallest for subtype IIA 2 (p = 0.04). Both the length (p = 0.03) and luminal diameter (p = 0.04) of the anterior tibial artery in men were significantly greater than in women in all the popliteal subtypes observed. Morphometric parameters of the right and left anterior tibial artery showed no statistically significant differences. The anterior tibial artery was the predominant vessel in a trifurcation (IB) and in the two subtypes with an anterior tibioperoneal trunk (IC, IIB). These results have implications in vascular grafting below the knee.

Angiographic study of the tibioperoneal trunks in patients with aorto-iliac occlusive disease

Knowledge of the normal anatomic characterization of the popliteal artery and its branches is essential as a guide in vascular surgery below the knee. Using radiologic, digital and statistical methods tibioperoneal trunks were studied on 76 preoperative arteriograms, visualizing bilateral configurations of the popliteal artery division, from 46 men and 30 women, with aorto-iliac occlusive disease. The aim of this study has been to evaluate tibioperoneal trunks as to typological (types, frequency of existence, gender and syntopic dimorphisms) and angiometric (length, internal diameter and capacity) aspects. The statistical analysis of tibioperoneal trunks (types, angiometric parameters) did not reveal any gender or syntopic dimorphisms (p > or = 0.05). In both the posterior tibioperoneal trunk (89.47%) or the anterior tibioperoneal trunk (7.89%) short and long ones were found. High correlation coefficients of the symmetry of the left and right vascular patterns were observed (r = 0.80-0.83). In 2.64% of cases tibioperoneal trunks were absent. Two types of posterior tibioperoneal trunk were longer (p < or = 0.01) but they were thinner (p < or = 0.05) than similarly named types of anterior tibioperoneaL trunk. In anterior and posterior tibioperoneal trunks of the short type the diameter of the vessel was statistically larger (p < or = 0.05) than in its long type. The largest capacity was found in the long type and the smallest in the short type of anterior tibioperoneal trunk (p < or = 0.01). These findings have implications in vascular grafting below the knee.

Patient with Leriche's syndrome and concomitant superior mesenteric aneurysm: Evaluation with contrast-enhanced three-dimensional magnetic resonance angiography, computed tomography angiography and digital subtraction angiography

Conventional angiography is regarded as the gold standard in vascular imaging but it is invasive, and difficulty may be encountered in the evaluation of aortic occlusion disease. Superior mesenteric artery aneurysm is an uncommon disease, which can result in life-threatening haemorrhage after rupture. With the rapid development of computed tomography angiography (CTA) and magnetic resonance angiography (MRA), high-quality images of the vascular system can be obtained in a non-invasive manner. We report a case of Leriche's syndrome with concomitant superior mesenteric aneurysm using contrast-enhanced 3-D CTA and MRA, with digital subtraction angiography correlation.

Bilateral Renal Artery Stenting in a Patient with Leriche Syndrome

Stenting for renal artery stenosis is well described in the literature. Bilateral renal artery stenting is not such a common procedure, however it is quite rare in patients with Leriche syndrome, as is the case we present.

[Atypical Leriche syndrome]

A 73-year old woman presented with mild paraparesis and hypesthesia of the legs. Furthermore, she complained dizziness, fainting and dyspnea. There was a history of peripheral artery disease, diabetes mellitus, arterial hypertension and chronic atrial fibrillation. Five years ago she had breast cancer with removal of the left mamma and additional radiation therapy. Cardiac catheterization at that time demonstrated no significant coronary stenoses. A contrast-enhanced CT-scan excluded lumbal spinal metastases. Instead, a subtotal occlusion of the abdominal aorta was noticed, but was initially interpreted as a chronic thrombosis because there were no typical symptoms and only moderate pain. About 24 hours later the patient developed an acute ischemic syndrome of the legs with progressive paraparesis, cold and pale legs in combination with acidosis and hyperventilation. Color-coded duplex ultrasound showed only a small turbulent flow in the ilial arteries, highly suspicious of a complete occlusion of the distal aorta. Angiography revealed an acute total occlusion of the infrarenal aorta without collaterals. During surgical intervention, complete obstruction of the abdominal aorta above the bifurcation was confirmed. Subsequent embolectomy was performed and an embolus consisting of several layers of different age was extracted. After successful surgical intervention with subsequent clinical improvement, the patient's clinical condition deteriorated a few day later. She died on day 9 after surgery from a complete ischemia of the small intestine and the colon ascendens.

Surgical management of chronic total occlusion of abdominal aorta

AIM

The surgical management of the totally occluded abdominal aorta is highly complex and possible complications are more likely to be seen. We reviewed our experience to make a base for future endoluminal procedures.

METHODS

Seventy-one patients with totally occluded abdominal aorta were operated between 1985 and 1998 in a main referral hospital of the social security organization and the results of vascular interventions were evaluated retrospectively. Juxtarenal aortic occlusion was seen in 52% of these patients. All the patients were operated using the transperitoneal approach and adequate dissection to control renal arteries. Limited thrombectomy through infrarenal aortotomy without transecting the aorta was done and continued with standard aortic graft insertion except for 1 patient with porcelain aorta.

RESULTS

Follow-up was 76.9+/-41.9 (SD) months. Fourteen patients had concurrent femoro-distal bypass and 2 patients had concurrent renal bypass. Perioperative mortality was 5.6% and 26.5% of patients needed a second intervention during follow-up. Five-, 10- and 13-year survival and freedom from secondary operation was as follows: 84%, 56% and 44%, 81%, 54% and 42%. Cumulative primary and secondary graft patencies at 5- and 10-years were 68%, 63% and 92%, 92%, respectively.

CONCLUSIONS

Surgical intervention is beneficial for patients with totally occluded aorta even if ischemic complaints are relatively mild and stable. Acceptable mortality rates and long-term results form a basis for future endovascular interventions.

[How urgent is the operation of bilateral occlusion of the aortic bifurcation?]

INTRODUCTION

Symptoms of occluded aortic bifurcation are variable and consequently lead to the question "How urgent is the operation?".

PATIENTS AND METHODS

The diagnostic and therapeutic procedure is analysed retrospectively in 6 patients. The reason for the occlusion was thrombosis or embolism in 3 patients each.

RESULTS

A successful bilateral inguinal thrombembolectomy was the standard operative revascularisation. In 2 of 3 emergency cases with critical ischemia the operation was performed without preoperative imaging. 3 patients with non-critical ischemia were operated upon more than 12 hours after rising symptoms.

DISCUSSION

How urgent the operation is depends primarily on the extent of occlusion. In case of critical ischemia a revascularisation can be performed without angiography. However, a more extensive procedure, even a bifemoral bifurcation graft, must be taken into account.

[Acute Leriche's syndrome in a patient undergoing coronary artery bypass grafting with extracorporeal circulation]

We are reporting a case of an acute thromboembolic obstruction of the aortic bifurcation in a 66-year-old patient undergoing coronary artery bypass grafting with extracorporeal circulation. After declamping of the aorta, the arterial pressure measured in the femoral artery suddenly dropped, whereas the pressure measured in the aortic cannula and in both radial arteries stayed normal. Transoesophageal echocardiography was performed to exclude an acute aortic dissection. While the patient always had a constant sinus rhythm, an angiography following the end of surgery, showed a complete obstruction of the abdominal aorta. Subsequent embolectomy through bifemoral arteriotomies was performed and a histologically fresh embolus (6,5 g in weight) was extracted. Neither the pre- and intraoperative echocardiography, nor the preoperative ventriculography showed signs of an intracardiac thrombus. Insufficient anticoagulation and a lack of inhibitor potential were almost excluded. Considering the histological findings, we assumed that the embolus was formed intraoperatively. Without further complications the patient left our department on the 8th postoperative day.

Internal mammary artery perfusing Leriche's syndrome in association with significant coronary arteriosclerosis: four case reports and review of literature

Four cases of collateral perfusion of a lower extremity by way of an internal mammary artery in the presence of Leriche's syndrome are described. Angiographic documentation preceding coronary artery bypass grafting prevented an acutely ischemic leg in two of the cases.

Internal mammary artery perfusing the Leriche's syndrome

Two cases of collateral perfusion of a lower extremity, by way of an internal mammary artery, in the presence of Leriche's syndrome are described. The importance of recognizing this condition prior to coronary artery bypass grafting is emphasized.

[Surgical treatment of juxtarenal occlusion of the abdominal aorta]

Incidence, etiology and clinical course of chronic juxtarenal occlusion of the abdominal aorta have been studied. It was established that this type of lesion among other forms of occlusive disease of the aorto-ileal segment is encountered in 8.1% of patients. Inflammatory diseases of arteries prevailed as an etiologic factor. Diagnosis of this disease should be based on the use of complex up-to-date methods of examination. Roentgeno-contrast aortography in lateral position is of paramount importance in detection of upper level of thrombus spreading in the aorta. Original method of operative procedure used in 20 patients, has been developed with due regards for location of the occlusion, character of lesion of aortic walls and prophylaxis of intraoperative embolic complications. Restoration of blood flow in lower extremities without any intraoperative complications was obtained in all operated patients. In all suffering from symptomatic hypertension normalization of arterial pressure was obtained after the operation. Postoperative mortality rate made up 4.4%. The results obtained confirm high effectiveness of the above surgical treatment of patients with juxtarenal occlusion of the abdominal aorta.

[CT angiography in arterial occlusive disease: comparison of 3 rendering techniques]

PURPOSE

To evaluate different rendering techniques of CT data for the assessment of long vessel segments in peripheral vascular occlusive disease.

MATERIAL AND METHODS

40 CT angiograms (aortoiliac: n = 20, leg arteries: n = 20) were viewed using three different rendering techniques: 1, maximum intensity projection (MIP); 2, volume rendering (VR); 3, shaded surface display (SSD). CT angiograms were obtained in 6 or 8 projections. Axial cross-section images were analysed using an interactive cine mode. Intraarterial DSA was the standard in all cases.

RESULTS

The sensitivities for the diagnosis of occlusive disease were 100% (cross-section images), 94% (MIP), 91% (VR) and 93% (SSD). The specificities were 100%, 99%, 99% and 99%, respectively. For the accurate grading of high-grade (> 75%) stenoses, the sensitivities were 85% (cross-section images), 62% (MIP), 44% (VR) and 35% (SSD). Specificity was 99% for all techniques.

CONCLUSIONS

CTA is accurate in occlusive disease. Interactive viewing of cross-section images is the most accurate technique. MIP is superior to VR in the imaging of high-grade stenoses because contrast-to-noise ratio is high and thresholding is not necessary.

[Consecutive deep femoro-femoral shunting in Leriche's syndrome]

Reconstructive operations were carried out in the clinic on 437 patients with Leriche's syndrome in the recent 8 years. In 25 of them successive shunting of the vessels of the femoro-popliteal segment became necessary later because of inadequacy of the blood flow immediately after the first operation (15 patients) or consequent thrombosis of the femoral artery (10 patients). Trophic changes in the distal parts of the extremity, pain at rest or intermittent claudication occurring after 20-25 minutes of walking were the indications for resorting to successive shunting in the femoro-popliteal segment despite the maintained functioning of the shunt in the aortoiliac position. The deep femoral artery was used as the donor vessel in 12 operations among the 25 successive operations on patients with the Leriche's syndrome. It is noted that with the use of this vessel the successive operation becomes simpler technically and the length of the shunt can be reduced. Adequate restoration of blood flow in the extremity was attained in all patients after successive shunting of vessels in the femoral segment with the use of the deep femoral artery, and persisted for 6 to 12 months.

Digital angiography using hand-operated table movement for vascular disease of the pelvis and lower extremities

We developed a new technique using hand-operated table movement during digital angiography (DA) for the study of vascular disease of the pelvis and lower extremities. Digital video memory (DVM) is used in this technique to digitize, record, and display fluorographic images without subtraction in real time. This allows free table movement and the imaging of a large area with a single injection of contrast medium. Forty-five examinations for vascular disease of the pelvis and lower extremities were performed by this DA technique. Good images of an extensive area from the lower abdomen to the lower leg were obtained in a single study.

Leriche's syndrome

Leriche's syndrome will be seen by the podiatric physician, and it can be misinterpreted as pain secondary to mechanical etiology. Often, symptoms of buttock or thigh pain occurring during walking resemble those seen with symptomatic pronation, so this disease entity must be ruled out.

Supraceliac aorta-to-femoral artery bypass: a case report

The authors describe the technique of the supraceliac aorta-to-femoral artery bypass graft. This type of reconstruction is presented as a possible alternative in patients with relative contraindications to direct approach of the infrarenal abdominal aorta.

Invasive imaging of abdominal aortic occlusions: intravenous versus intra-arterial route

We studied 16 patients of abdominal aortic occlusion by digital subtraction angiography (DSA) in order to assess the advantages and limitations of Intravenous (IV) and Intra-arterial (IA) imaging in this rare clinical setting. All the patients had systemic hypertension and 14 patients (87.5%) also had associated coronary artery disease. Ten patients underwent IV-DSA and all were diagnostic. Eight of them had "stable" angina and, of these three patients (37.5%) developed clinical features of angina pectoris 5 to 10 minutes after the study. The remaining 6 patients who had "unstable" angina underwent an uneventful IA-DSA by transbrachial route. Intravenous DSA should be performed with caution since both the central venous contrast injection and Buscopan injection, used to control intestinal peristalsis, result in a transient increase in the cardiac workload, increase the myocardial oxygen demand and can precipitate myocardial ischaemia in the "high-risk" coronary patients. These patients should be electively studied by IA-DSA by transbrachial route inspite of the fact that IV-DSA examinations, if done, are usually diagnostic.

[The value of intravenous digital subtraction angiography in Leriche's syndrome]

The value of intravenous digital subtraction angiography was examined in 20 patients with Leriche's syndrome. The method is highly accurate for localising the level of the aortic occlusion (100%), the demonstration of distal patency (95%) and the collateral circulation (90%). An important advantage of this method compared with transaxillary, transbrachial or translumbar aortography is its low invasiveness.

[Spontaneous lysis of acute Leriche syndrome]

Usually, obstructions of the terminal aorta require surgery involving an aortobifemoral bypass, especially if they occur with acute signs and symptoms, the clinical pattern of these signs being very marked. The authors report on a case where an extensive obstruction of the lumbar aorta and of the pelvic vessels finally dissolved without on-target therapeutic intervention via an obviously spontaneous lysis.

Radiology of aortoarteritis

Based mainly on the practice and experience in China, the radiology of aortoarteritis, including plain film and angiographic manifestations and its correlation to clinical syndromes, is reviewed in this article. The preliminary results of percutaneous transluminal angioplasty in the management of renovascular hypertension due to aortoarteritis are described briefly and discussed.

The Leriche syndrome. A comparative investigation using angiography, computed tomography and ultrasonography

Nine patients with Leriche syndrome were examined with angiography, computed tomography and routine abdominal ultrasonography. The diagnosis was readily obtained with angiography and computed tomography, while ultrasonography conducted with a linear array real time scanner failed to establish essential features of the disorder. This is mainly because the thrombosed portion of the aorta does not produce any striking alteration of the echo structure of the vessel. Contrast computed tomography defines the abnormalities of the aorta in great detail.

An unusual angiographic appearance of aorto-iliac disease presenting as the Leriche syndrome

An unusual angiographic presentation of Leriche syndrome is described that demonstrates short segment occlusions of iliac arteries with bilaterally symmetrical post-stenotic dilatations.