What’s causing this patient’s diminished femoral pulses?

February 07, 2018

Figure 1 Quiz of the Week

A 56-year-old man presents with a three-month history of erectile dysfunction and bilateral buttock pain on exertion, but not at rest. His past medical history is significant for type 2 diabetes, dyslipidemia, and hypertension. Examination reveals bilaterally diminished femoral pulses.

What is the most likely diagnosis?

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Answer: Leriche syndrome (aortoiliac occlusive disease)

Leriche syndrome (aortoiliac occlusive disease) is defined by the presence of erectile dysfunction, claudication of the buttocks and legs, and decreased or absent femoral pulses. It occurs when blood flow to the common iliac arteries is chronically occluded near the aortic bifurcation. As the disease progresses, collateral vessels may form. Management may include endarterectomy, bypass surgery, or angioplasty.

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