The sudden onset of symptomatic hemorrhoid disease in a 43 year old man heralded infrarenal aortic thrombosis after a minor fall. He developed a classic Leriche Syndrome and required aortic thrombectomy and aorto-bifemoral grafting. The unusual presentation is explained by the collateral circulation and arteriograms demonstrating this point are presented. It was felt that the pres ence of pre-existing sub-occlusive iliac disease predisposed this patient to aortic thrombosis and a successful outcome followed surgical treatment.
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