Treatment of Leriche Syndrome with Absent Femoral Pulse in Acute Limb Ischemia from In Situ Native-Vessel Thrombosis

This protocol addresses a distinct presentation of Leriche syndrome in which acute limb ischemia arises from in situ thrombosis of the native vessel — not thromboembolism, atheroembolism, or graft failure.

Clinical scenario: Acute-onset lower-extremity pain, absent femoral pulse on examination, and a long prior history of claudication, with no recent surgical intervention. Ischemia is due to in situ native-vessel thrombosis.

Acute limb ischemia can result from several distinct pathways — including thromboembolism, atheroembolism, in situ native-artery thrombosis, or surgical bypass graft thrombosis. Identifying the correct mechanism directly shapes the management approach.

For a viable limb with native-vessel thrombosis, the treatment approach centres on thrombolytic therapy — the full structured regimen, decision criteria, and adjunctive steps are available in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

Long history of claudication. Acute-onset left lower-extremity pain. Absent left femoral pulse by palpation, faint audible DP and PT Doppler signals.
ALI occurs because of thromboembolism, atheroembolism, in situ thrombosis of the native artery, or thrombosis of a surgical bypass graft.
For native-vessel thrombosis, a trial of thrombolytic therapy is helpful for viable limbs.

DOI: 10.1016/j.jacr.2025.02.024

View source ↗