title: Leriche syndrome in a patient with situs inversus totalis.
abstract: Situs inversus is a rare congenital defect defined by a mirror image anatomic variation of the thoracic and abdominal organs. In this situation, abdominal aortic surgery may become particularly challenging. This is the case of a 51-year-old man, who presented with an incapacitating lower limb claudication. On his workup, a complete occlusion of the infrarenal aorta requiring surgical revascularization was found. Additionally, a situs inversus totalis was identified along with a single horseshoe kidney. The patient underwent uneventfully a surgical aortobifemoral interposition. The sole modification to the standard procedure regarded the graft limbs tunneling, which was performed in a prerenal pathway in the retroperitoneal space, thus avoiding iatrogenic injury to the anteriorly positioned iliac veins. Although challenging, conventional aortic surgery can be safely accomplished in patients with situs inversus totalis.
authors.affiliation: Department of Angiology and Vascular Surgery, Divino Espírito Santo Hospital-Ponta Delgada, São Miguel Azores, Portugal. Electronic address: nfgoliveira@sapo.pt.
authors.forename: Nelson
authors.initials: N
authors.lastname: Oliveira
authors.affiliation: Department of Angiology and Vascular Surgery, Divino Espírito Santo Hospital-Ponta Delgada, São Miguel Azores, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Oliveira
authors.affiliation: Department of Angiology and Vascular Surgery, Divino Espírito Santo Hospital-Ponta Delgada, São Miguel Azores, Portugal.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Dias
authors.affiliation: Department of Angiology and Vascular Surgery, Divino Espírito Santo Hospital-Ponta Delgada, São Miguel Azores, Portugal.
authors.forename: Lisa
authors.initials: L
authors.lastname: Borges
authors.affiliation: Department of Angiology and Vascular Surgery, Divino Espírito Santo Hospital-Ponta Delgada, São Miguel Azores, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cássio
mesh_terms: D015901:Angiography, Digital Subtraction; D019917:Blood Vessel Prosthesis Implantation; D000069337:Fused Kidney / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007925:Leriche Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012857:Situs Inversus / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome