# Collateral anastomosis in Leriche syndrome complicated by presumed mycotic thoracoabdominal aneurysm

## TL;DR

A rare case of Leriche syndrome combined with a suspected mycotic aneurysm is reported, emphasizing the complex vascular complications from drug abuse and blood clotting disorders.

## Contribution

The paper presents a unique case combining Leriche syndrome and a mycotic aneurysm, highlighting diagnostic challenges in vascular complications.

## Key findings

- The patient had chronic aortoiliac occlusion and a suspected mycotic thoracoabdominal aneurysm.
- Lower-limb perfusion relied on collateral pathways due to the occlusion.
- The case is linked to intravenous drug abuse and thrombophilia.

## Abstract

Leriche syndrome can remain clinically silent when collateral pathways preserve lower-limb perfusion; however, coexistence with infectious aortic pathology poses a considerable diagnostic challenge for the radiologist. We report a rare case of a 49-year-old male who presented with acute back pain and dysphagia; CT imaging demonstrated a chronic aortoiliac occlusion alongside a suspected mycotic thoracoabdominal aortic aneurysm. Notably, perfusion of the lower limbs was entirely dependent on bilateral internal thoracic–epigastric collateral pathways. This unusual combination highlights the broad spectrum of vascular complications associated with intravenous drug abuse and thrombophilia.