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Aortoiliac occlusive disease (Leriche)
Occlusive disease of the abdominal aorta and iliac arteries causes buttock and thigh claudication, absent femoral pulses and erectile dysfunction (Leriche syndrome); after a trial of medical therapy and walking exercise, most lesions are now treated with stents — including covered stents at the bifurcation — and aortobifemoral bypass remains the most durable treatment for extensive disease in a fit patient.
Why it matters in the exam
The typical question describes a male smoker in his 50s with buttock and thigh claudication, weak or absent femoral pulses on both sides and erectile dysfunction — a combination recognised as Leriche syndrome. A special group is relatively young female smokers with a small aorta. Diagnosis starts with ABI and continues with duplex or CTA. The classic TASC II classification grades lesions from A (short and simple, suitable for endovascular treatment) to D (extensive aortoiliac occlusion, previously treated surgically). Today, in experienced centres, even complex lesions are treated endovascularly first, for example CERAB — reconstruction of the bifurcation with covered stents — or "kissing" stents. Results in the iliac arteries are better than in the arteries below the groin.
For claudication alone one starts with smoking cessation, statin, antiplatelet therapy and supervised walking exercise for 3 months, and revascularisation is considered when claudication is still very limiting. Aortobifemoral bypass is a very durable operation, with high patency rates over years, and suits a fit patient with extensive disease or when endovascular treatment has failed. In a high surgical risk patient or an infected field "extra-anatomic" bypasses are used: axillobifemoral bypass, or a femorofemoral crossover bypass when only one iliac artery is occluded. Complications of aortic bypass: graft limb occlusion, graft infection, aortoenteric fistula (gastrointestinal bleeding years after surgery), colonic ischaemia from ligation of the inferior mesenteric artery, sexual dysfunction and ureteric injury.
In every patient with peripheral arterial disease coronary and carotid disease are also sought, because they are the main causes of death.
Key points
- Leriche — buttock claudication, weak femoral pulses, erectile dysfunction.
- Walking exercise and medical therapy first.
- Most lesions — stents.
- Aortobifemoral bypass — the most durable.
- Extra-anatomic for a high-risk patient.
Summary table
| Treatment | For whom | Note |
|---|---|---|
| Medical therapy and walking exercise | Every patient with claudication | 3 months before deciding on revascularisation |
| Stents (including CERAB or kissing) | Most lesions | Good results in the iliac arteries |
| Aortobifemoral bypass | Fit patient with extensive disease or endovascular failure | The most durable |
| Axillobifemoral bypass | High surgical risk or infected field | Extra-anatomic, lower patency |
| Femorofemoral bypass | Occlusion of one iliac artery | Extra-anatomic |
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Sources
- ESVS Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication, 2024 — Aorto-iliac revascularisation
- TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease, 2007 — Aorto-iliac lesion classification
- Rutherford's Vascular Surgery and Endovascular Therapy, 10th edition (2022) — Aortoiliac occlusive disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.