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Ruano Restrepo, M. I. ., Londoño Castro, M. L. ., Pineda Muñoz, M., & Rentería Daboín, J. . (2018). Caso clínico de interés : síndrome de Leriche. Una manifestación inusual de la enfermedad arterial periférica. Biosalud, 17(2), 105–111. https://doi.org/10.17151/biosa.2018.17.2.7
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El síndrome de Leriche es una condición causada por la obstrucción de las ramas principales de la aorta abdominal por debajo de la salida de las arterias renales con compromiso de todo el árbol arterial, incluyendo las iliacas y femorales. Se presenta un paciente masculino de 62 años de edad con antecedentes de tabaquismo y que consulta al servicio de urgencias por un cuadro clínico de 3 meses de evolución consistente en dolor de miembros inferior, linfedema que predomina en el miembro inferior izquierdo, además de ausencia de pulsos en miembros inferiores. Al aplicar el test IIEF-5 se obtiene una disfunción eréctil moderada. Es importante resaltar este síndrome y la necesidad de diagnosticarlo tempranamente debido a sus consecuencias catastróficas, haciendo énfasis en identificar e intervenir en los factores de riesgo que conllevan a esta presentación inusual de la enfermedad arterial periférica.
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1. Messner B, Bernhard D. Smoking and cardiovascular disease: Mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol. 2014; 34 (3): 509-515.
2. Bernhard D, Csordas A, Henderson B, Rossmann A, Kind M, Wick G. Cigarette smoke metal-catalyzed protein oxidation leads to vascular endothelial cell contraction by depolymerization of microtubules. The FASEB J Off Publ Fed Am Soc Exp Biol. 2005; 19 (9): 1096-1107.
3. Leriche R, Morel A. The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation. Ann Surg. 1948; 127 (2): 193-206.
4. Lee W-J, Cheng Y-Z, Lin H-J. Leriche syndrome. Int J Emerg Med. 2008; 1 (3): 223.
5. Frederick M, Newman J, Kohlwes J. Leriche Syndrome. J Gen Intern Med. 2010; 25 (10): 1102-1104.
6. Hama Y, Kaji T. Computed tomography-guided balloon-assisted endovascular recanalization and angioplasty in Leriche syndrome. Pers Med Universe. 2016; 5: 41-43.
7. Kałka D, Karpiński Ł, Gebala J, Rusiecki L, Biełous-Wilk A, Krauz ES, et al. Sexual health of male cardiac patients-present status and expectations of patients with coronary heart disease. Arch Med Sci AMS. 2017; 13 (2): 302-310.
8. Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral arter disease. Semin Interv Radiol. 2014; 31 (4): 378-388.
9. Talukder MAH, Johnson WM, Varadharaj S, Lian J, Kearns PN, El-Mahdy MA, et al. Chronic cigarette smoking causes hypertension, increased oxidative stress, impaired NO bioavailability, endothelial dysfunction, and cardiac remodeling in mice. Am J Physiol-Heart Circ Physiol. 2011; 300 (1): 388-396.
10. Csiszar A, Podlutsky A, Wolin MS, Losonczy G, Pacher P, Ungvari Z. Oxidative stress and accelerated vascular aging: Implications for cigarette smoking. Front Biosci J Virtual Libr. 2009; 14: 3128-3144.
11. Powell JT. Vascular damage from smoking: Disease mechanisms at the arterial wall. Vasc Med. 1998; 3 (1): 21-28.
12. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: An update. J Am Coll Cardiol. 2004; 43 (10): 1731-1737.
13. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK53012/.
14. Lee J-E, Cooke JP. The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis. 2011; 215 (2): 281-283.
15. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2007; 33 (Suppl. 1): 1-75.
16. Bhatia MS, Gautam P, Saha R. Leriche Syndrome Presenting as Depression with Erectile Dysfunction. J Clin Diagn Res JCDR. 2016; 10 (3): VD01-VD02.
17. Muñoz Chavéz J, Solarte Pineda H, Imbachi R. Caso Clínico de interés: síndrome de Leriche. Revista Colombiana Salud Libre. 2016; 11 (1): 57-61.
18. Verim S, Taşçı I. Doppler ultrasonography in lower extremity peripheral arterial disease. Turk Kardiyol
Dernegi Arsivi Turk Kardiyol Derneginin Yayin Organidir. 2013; 41 (3): 248-255.
19. Chou R, Dana T, Blazina I, Daeges M, Bougatsos C, Grusing S, et al. Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK396415/.
20. Peters RJG, Mehta SR, Fox KAA, Zhao F, Lewis BS, Kopecky SL, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation. 2003; 108 (14): 1682-1687.
21. Bedenis R, Stewart M, Cleanthis M, Robless P, Mikhailidis DP, Stansby G. Cilostazol for intermittent claudication. Cochrane Database Syst Rev. 2014; 10: CD003748.
22. Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, et al. Authors’ reply: Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg. 2013; 100 (13): 1838-1839.
23. Hirsch AT, Treat-Jacobson D, Lando HA, Hatsukami DK. The role of tobacco cessation, antiplatelet and lipid-lowering therapies in the treatment of peripheral arterial disease. Vasc Med Lond Engl. 1997; 2 (3): 243-251.
24. Cole CW, Hill GB, Farzad E, Bouchard A, Moher D, Rody K, et al. Cigarette smoking and peripheral arterial occlusive disease. Surgery. 1993; 114 (4): 753-756.
25. Jonason T, Bergström R. Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality. Acta Med Scand. 1987; 221 (3): 253-260.
26. Higashihara T, Shiode N, Kawase T, Tamekiyo H, Otsuka M, Okimoto T, et al. Endovascular Therapy Is Effective for Leriche Syndrome with Deep Vein Thrombosis. Case Rep Cardiol. 2015; 2015: 395205.
27. Serrano Hernando F, Martín Conejero A. Enfermedad arterial periférica: aspectos fisiopatológicos, clínicos y terapéuticos. Rev Esp Cardiol. 2007; 60 (09): 969-982.
28. Norgren L, Hiatt WR, Bell K, Nehler MR, Harris KA, Fowkes FGR, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33 (Suppl. 1): 1-70.
29. Martínez J, Díaz J, Luján V, Fernández M, Ramírez E. Enfermedad oclusiva aortoilíaca o síndrome de Leriche. Rev Colomb Cir. 2017; 32: 214-222.
30. Chiesa R, Marone EM, Tshomba Y, Logaldo D, Castellano R, Melissano G. Aortobifemoral bypass grafting using expanded polytetrafluoroethylene stretch grafts in patients with occlusive atherosclerotic disease. Ann Vasc Surg. 2009; 23 (6): 764-769.
31. Frankini AD, Lichtenfels E, Frankini A, Frankini T. Extra-anatomical arterial bypass of the aortoiliac segment: 15-year experience. J Vasc Bras. 2007; 6 (3): 204-210.
32. Goiriz-Valdésa R, Fernández-Herrera J. Enfermedad de Buerger (tromboangeítis obliterante) Buerger’s disease (thromboangiitis obliterans). Actas Dermosifiliogr. 2005; 96 (9): 553-562.
2. Bernhard D, Csordas A, Henderson B, Rossmann A, Kind M, Wick G. Cigarette smoke metal-catalyzed protein oxidation leads to vascular endothelial cell contraction by depolymerization of microtubules. The FASEB J Off Publ Fed Am Soc Exp Biol. 2005; 19 (9): 1096-1107.
3. Leriche R, Morel A. The Syndrome of Thrombotic Obliteration of the Aortic Bifurcation. Ann Surg. 1948; 127 (2): 193-206.
4. Lee W-J, Cheng Y-Z, Lin H-J. Leriche syndrome. Int J Emerg Med. 2008; 1 (3): 223.
5. Frederick M, Newman J, Kohlwes J. Leriche Syndrome. J Gen Intern Med. 2010; 25 (10): 1102-1104.
6. Hama Y, Kaji T. Computed tomography-guided balloon-assisted endovascular recanalization and angioplasty in Leriche syndrome. Pers Med Universe. 2016; 5: 41-43.
7. Kałka D, Karpiński Ł, Gebala J, Rusiecki L, Biełous-Wilk A, Krauz ES, et al. Sexual health of male cardiac patients-present status and expectations of patients with coronary heart disease. Arch Med Sci AMS. 2017; 13 (2): 302-310.
8. Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral arter disease. Semin Interv Radiol. 2014; 31 (4): 378-388.
9. Talukder MAH, Johnson WM, Varadharaj S, Lian J, Kearns PN, El-Mahdy MA, et al. Chronic cigarette smoking causes hypertension, increased oxidative stress, impaired NO bioavailability, endothelial dysfunction, and cardiac remodeling in mice. Am J Physiol-Heart Circ Physiol. 2011; 300 (1): 388-396.
10. Csiszar A, Podlutsky A, Wolin MS, Losonczy G, Pacher P, Ungvari Z. Oxidative stress and accelerated vascular aging: Implications for cigarette smoking. Front Biosci J Virtual Libr. 2009; 14: 3128-3144.
11. Powell JT. Vascular damage from smoking: Disease mechanisms at the arterial wall. Vasc Med. 1998; 3 (1): 21-28.
12. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: An update. J Am Coll Cardiol. 2004; 43 (10): 1731-1737.
13. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK53012/.
14. Lee J-E, Cooke JP. The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis. 2011; 215 (2): 281-283.
15. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2007; 33 (Suppl. 1): 1-75.
16. Bhatia MS, Gautam P, Saha R. Leriche Syndrome Presenting as Depression with Erectile Dysfunction. J Clin Diagn Res JCDR. 2016; 10 (3): VD01-VD02.
17. Muñoz Chavéz J, Solarte Pineda H, Imbachi R. Caso Clínico de interés: síndrome de Leriche. Revista Colombiana Salud Libre. 2016; 11 (1): 57-61.
18. Verim S, Taşçı I. Doppler ultrasonography in lower extremity peripheral arterial disease. Turk Kardiyol
Dernegi Arsivi Turk Kardiyol Derneginin Yayin Organidir. 2013; 41 (3): 248-255.
19. Chou R, Dana T, Blazina I, Daeges M, Bougatsos C, Grusing S, et al. Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK396415/.
20. Peters RJG, Mehta SR, Fox KAA, Zhao F, Lewis BS, Kopecky SL, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation. 2003; 108 (14): 1682-1687.
21. Bedenis R, Stewart M, Cleanthis M, Robless P, Mikhailidis DP, Stansby G. Cilostazol for intermittent claudication. Cochrane Database Syst Rev. 2014; 10: CD003748.
22. Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, et al. Authors’ reply: Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg. 2013; 100 (13): 1838-1839.
23. Hirsch AT, Treat-Jacobson D, Lando HA, Hatsukami DK. The role of tobacco cessation, antiplatelet and lipid-lowering therapies in the treatment of peripheral arterial disease. Vasc Med Lond Engl. 1997; 2 (3): 243-251.
24. Cole CW, Hill GB, Farzad E, Bouchard A, Moher D, Rody K, et al. Cigarette smoking and peripheral arterial occlusive disease. Surgery. 1993; 114 (4): 753-756.
25. Jonason T, Bergström R. Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality. Acta Med Scand. 1987; 221 (3): 253-260.
26. Higashihara T, Shiode N, Kawase T, Tamekiyo H, Otsuka M, Okimoto T, et al. Endovascular Therapy Is Effective for Leriche Syndrome with Deep Vein Thrombosis. Case Rep Cardiol. 2015; 2015: 395205.
27. Serrano Hernando F, Martín Conejero A. Enfermedad arterial periférica: aspectos fisiopatológicos, clínicos y terapéuticos. Rev Esp Cardiol. 2007; 60 (09): 969-982.
28. Norgren L, Hiatt WR, Bell K, Nehler MR, Harris KA, Fowkes FGR, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33 (Suppl. 1): 1-70.
29. Martínez J, Díaz J, Luján V, Fernández M, Ramírez E. Enfermedad oclusiva aortoilíaca o síndrome de Leriche. Rev Colomb Cir. 2017; 32: 214-222.
30. Chiesa R, Marone EM, Tshomba Y, Logaldo D, Castellano R, Melissano G. Aortobifemoral bypass grafting using expanded polytetrafluoroethylene stretch grafts in patients with occlusive atherosclerotic disease. Ann Vasc Surg. 2009; 23 (6): 764-769.
31. Frankini AD, Lichtenfels E, Frankini A, Frankini T. Extra-anatomical arterial bypass of the aortoiliac segment: 15-year experience. J Vasc Bras. 2007; 6 (3): 204-210.
32. Goiriz-Valdésa R, Fernández-Herrera J. Enfermedad de Buerger (tromboangeítis obliterante) Buerger’s disease (thromboangiitis obliterans). Actas Dermosifiliogr. 2005; 96 (9): 553-562.
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