腹部大動脈瘤の血栓性完全閉塞によりLeriche症候群を来した1例

A Case of Leriche Syndrome Associated with Complete Thrombotic Obstruction of an Abdominal Aortic Aneurysm

　腹部大動脈瘤の血栓性完全閉塞によりLeriche症候群を来した症例を経験した．腹部大動脈瘤が慢性に完全閉塞してLeriche症候群を呈する例は稀であり，その報告も少ない．症例は70歳，男性で，約10年前より次第に増悪する間欠性跛行，下肢の萎縮および陰萎などの典型的なLeriche症候群の症状を主訴に当科を受診した．血管造影で腹部大動脈は両側の腎動脈分岐部直下で完全閉塞し，側副血行路を介して両側の外腸骨動脈以下が造影されていた．腹部CTで腎動脈下の腹部大動脈に，血栓により完全閉塞した腹部大動脈瘤を認めた．以上より，腹部大動脈瘤に合併したLeriche症候群と診断し，腋窩動脈—両側大腿動脈バイパス術を行い症状は改善した．しかし，大動脈内血栓の上行進展による諸臓器障害や瘤の拡大破裂の危険性が残る．

We reported a case of Leriche syndrome associated with complete thrombotic obstruction of an abdominal aortic aneuysm. Reports about chronic occlusion as-sociated with an abdominal aortic aneuysm are very rare. A 70-year-old man came to our hospital with his chief complaints being typical symptoms of Lerichesyndrome such as intermittent claudication, atrophy of the lower extremities and impotence which had been progressive over the past 10 years. Intravenous digital angiography showed that the abdominal aorta was completely occluded from just below the renal arteries to include both of the common iliac arteries. Both external iliac arteries were patent for well-developed collateral path ways. Abdominal CT scan showed a thrombosed abdominal aortic aneuysm below the renal arteries. We diagnosed Leriche syndrome associated with complete thrombotic obstruction of an abdominal aortic aneuysm and treated the patient with axillo-bifemoral bypass grafting. After that, symptoms of Leriche syndrome were relieved. In such cases, how-ever, careful consideration should be given to several risk factors such as delayed aortic rupture and dysfunc-tion of various viscera due to thrombotic progression in the upper abdominal aorta.