Leriche Syndrome in the Setting of Coronary Artery Bypass Grafting

Abstract

We present the case of a 60-year-old male with Leriche Syndrome discovered on cardiac catheterization in preparation for coronary artery bypass grafting. While the patient was in the operating room receiving sedation and preoxygenation, additional angiography was requested to determine the routes of collateralization to the lower extremities. Because no route could be established with existing angiographic images, the case was canceled before induction of anesthesia. It was later determined by further testing that collateral flow to the bilateral lower extremities was dependent on the bilateral internal mammary arteries. This patient was subject to increased morbidity due to the inability to determine collateral flow and appropriate grafting vessels prior to the scheduled operation, leading to delay in treatment. Leriche Syndrome, or aortoiliac occlusive disease, is a known, but infrequently encountered coexisting disease process in patients presenting for coronary artery bypass grafting (CABG) procedures. Recognizing the importance of its implications specific to CABG surgery can help to avoid major postoperative morbidity and mortality through proper evaluation and surgical consideration.