This protocol addresses Leriche syndrome presenting as acute limb ischemia in a patient with known atrial fibrillation who underwent spine surgery within the past month. The presentation includes sudden-onset lower-extremity pain, diminished pulses, and an isolated filling defect in the common iliac artery on imaging.
The coexistence of atrial fibrillation as a potential embolic source and a recent spinal surgical procedure creates a clinically constrained situation. Not all standard approaches to acute arterial occlusion are appropriate here — the recent surgery directly limits which interventional options can be safely pursued.
Urgent restoration of blood flow to the ischemic limb is the primary goal. The revascularization strategy in this setting must account for the patient's recent spinal surgery, which significantly influences which interventions are appropriate and which must be avoided. The full protocol details the specific approach for this combination of factors.
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.
Options for more-definitive initial therapy include expeditious catheter-directed mechanical thrombectomy or surgical revascularization to restore blood flow to the limb and limit irreversible tissue damage.
Extreme caution should be taken with tPA administration in a patient who has recently undergone spinal surgery.
DOI: 10.1016/j.jacr.2025.02.024
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