Leriche Syndrome with Persistent Intermittent Claudication After Medical Therapy and Supervised Exercise

Clinical scenario

Symptomatic peripheral arterial disease with intermittent claudication, in the absence of rest pain, nonhealing wounds, acute limb ischemia, or chronic limb-threatening ischemia.

Prior treatment — insufficient response

Initial management with antiplatelet therapy (acetylsalicylic acid or clopidogrel), cilostazol, supervised exercise therapy, and best medical management (statin, antihypertensive, and metabolic therapy) did not achieve adequate improvement in walking distance. This protocol addresses what comes next.

Next-line approach

When conservative measures fail to improve walking distance, an endovascular revascularization approach targeting the aortoiliac arterial segment is considered, together with specific antithrombotic adjunctive therapy.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jacr.2025.02.024

For initial management of any patient without lifestyle-limiting claudication or evidence of rest pain or nonhealing wounds, it is recommended that antiplatelet adjunctive therapy be initiated.

Severe claudication without rest pain.

Primary stenting for patients with TASC A-D aortoiliac artery lesions can be useful.

A combination of rivaroxaban 2.5 mg twice per day and ASA 100 mg daily was shown to reduce CV-related death, MI, or stroke compared with ASA alone or rivaroxaban alone.

Heparin may be used as adjunctive therapy during endovascular intervention if indicated.

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