Treatment of Leriche Syndrome with Atrial Fibrillation and Acute Limb Ischemia Following Recent Spine Surgery

This protocol covers aortoiliac occlusive disease presenting as acute limb ischemia in a patient with known atrial fibrillation who has had spine surgery within the past month — a scenario requiring immediate vascular decision-making.

Clinical Scenario

Known atrial fibrillation and spine surgery within the past month. Sudden-onset lower-extremity pain with diminished distal pulses. Imaging reveals an isolated filling defect in the common iliac artery consistent with acute arterial occlusion.

Approach to Management

Immediate anticoagulation is a critical first step — initiated promptly to limit ongoing thrombus extension while further treatment decisions are made. The choice of agent, route, and subsequent steps are defined in the full protocol.

The complete treatment algorithm is available below.

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References

Known atrial fibrillation and spine surgery performed within the past month. Sudden-onset right lower-extremity pain. Diminished pulses in right lower-extremity. CTA demonstrates isolated filling defect in right common iliac artery.

All patients presenting with ALI can benefit from immediate initiation of anticoagulation therapy, generally a heparin drip.

This reduces the risk of thrombus propagation during the inevitable delay as treatment decisions are made.

DOI: 10.1016/j.jacr.2025.02.024

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