Teaching Case

A 32 years old man presented to the hospital with pain to his legs, sense of heaviness and parestesia. At the beginning these symptoms have been associated with a sedentary life and related to the use of motorcycle. Later on he consulted an urologist for impotentia which has been related to stress and to psycological disturbs. After few weeks he came to the hospital with an extremely painfulness to his inguinal region and to his legs .An eco color doppler has been requested and it revealed absence of flow in both the common iliac arteries .The patient came to our institute where a multislice spiral CT Angiography has been performed and showed the obstruction of the sub renal aorta and the presence of superficial collateral circles.

The Leriche syndrome is a chronic process associated with specific symptom complex: intermittent claudication of the buttocks and thighs and impotence; femoral or other distal pulses are absent. Typically the condition affects males in the 35 to 60 age group. The characteristic pathologic finding is a progressive atherosclerotic lesion in the wall of the abdominal aorta with superimposed thrombosis. The occlusion may involve any portion of the abdominal aorta, usually arising from the iliac bifurcation. Multislice spiral CT Angiography allowed to acquire a very large anatomic region in a extremely short time (Fig. 1), with excellent arterial enhancement. The scanned volume, from the celiac trunk to the distal arteries of the ankles was acquired and post-processed .We used the Volume Rendering (VR) technique to better visualize the vascular anatomy, the presence and the location of collateral vessels. The 360° rotation of the image (Fig.2) showed a perspective vision and allowed to distinguish vascular tree from bony structure. Multislice spiral CTA study confirmed the diagnosis; occlusion of the abdominal aorta as well as iliac vessels and distal recanalization were demonstrated on both axial and reformatted images (Fig.3). The method is highly accurate to locate the aortic occlusion the presence of concomitant occlusive disease affecting the renal and visceral arteries, the type and extent of collateralization and the level of the most proximal graftable arterial segments. He successfully underwent surgery and post-procedure images were obtained (Fig.4).