MANAGEMENT OF AORTIC OCCLUSION SYNDROME ASSOCIATED TO GRAVES DISEASE

Background :Leriche syndrome or aortoiliac occlusion disease is caused by atherosclerosis and manifests as a constellation of symptoms that include claudication, erectile dysfunction, and the notable absence of femoral pulses. Graves disease (also known as Basedow) is an autoimmune disorder characterized by excessive thyroid hormone production, leading to hyperthyroidism. It often results in symptoms such as weight loss, rapid heart rate, tremors, and an enlarged thyroid gland (goiter).We present a case study detailing a singular occurrence of Leriche syndrome in a patient concurrently diagnosed with Graves disease, emphasizing the intricate nuances encountered in anesthesia management across both surgical procedures.

Case presentation: A 53-year-old North African male with history of smoking presented to the ED with critical limb ischemia. The patient exhibited normal vital signs, except for a sinus tachycardia of 140 beats per minute. Initial blood laboratory tests yielded no abnormalities. However, abdominopelvic computed tomography angiography (CTA) revealed an abdominal aortic aneurysm measuring 46mm in diameter and extending over 107mm. This aneurysm was found to be partially thrombosed above the renal arteries, with complete thrombosis noted at the infrarenal level, extending bilaterally to the iliac arteries. The presence of collateral blood vessels supported the diagnosis of Leriche syndrome. Additionally, further investigation into the sinus tachycardia revealed the patients diagnosis of Graves disease, complicating the vascular surgery. After collegial discussion, a two-stage surgical approach was decided upon. Initially, the patient underwent medical treatment using a rapid thyroid hormone blocking protocol to manage the signs of hyperthyroidism. Following achievement of biochemical and clinical euthyroidism, characterized by stable thyroid hormone levels, the first surgery, total thyroidectomy, was performed. Subsequently, a few days later, the patient underwent a bypass surgery. The postoperative course was marked by successful bypass graft surgery, resulting in improved limb function and absence of further complications. The patient was discharged home 10 days after the second surgery.

Conclusion : In this case, the challenge lay in managing both conditions while ensuring controlled heart rate and blood pressure to prevent aneurysm rupture, and concurrently administering anticoagulant therapy to prevent thrombus extension. Our findings suggest that in comparable cases, emphasis on thorough physical examination and medical history is crucial, and interdisciplinary collaboration between different specialties enhances patient survival.