Snapshot A 62-year-old man presents to his primary care physician complaining of pain and numbness in his left leg during ambulation. This pain is always relieved by rest. He also complains of impotence. PE reveals atrophy of the left leg muscles, normal reflexes, and a bruit over the left femoral artery. Introduction Leriche's Syndrome (aortoiliac occlusive disease) is a form of peripheral vascular disease (PVD) caused by atherosclerosis of the aorta is it transitions to the aortoiliac vessels characterized by buttock claudication decreased femoral pulses male impotence Presentation Symptoms intermittent claudication reproducable leg pain that occurs when walking initially relieved by rest may worsen and progress to pain at rest and ischemia male impotence indicates involvement of the hypogastric arteries Physical exam diminished femoral pulses femoral bruits on ausculation atrophy of calf muscles ankle-brachial index indicative of PVD ankle systolic pressure <90% of brachial systolic readings other signs of peripheral artery disease Evaluation Doppler ultrasound diagnostic gold standard identifies stenosis and occlusion of aortoiliac vessels ankle-brachial index is the best initial test Arteriography and digital subtraction angiography necessary for surgical evaluation Differential Acute ischemia, diabetic vasculitis, Buerger's vasculitis, and sciatica. Treatment Nonoperative lifestyle modifications & medical managment control underlying conditions control diabetes, HTN, hyperlipedia etc. lifestyle modifications smoking cessation exercise regimen improves development of collateral blood flow medical management aspirin cilostazol thromboxane inhibitors anticoagulants to prevent clot formation and acute ischemia Operative angioplasty and stenting success of which is highly dependent on area of occlusion arterial bypass surgery indicated only when conservative treatment fails and angioplasty not an option amputation indicated as salvage procedure Prognosis, Prevention, and Complications Prognosis clinical outcomes can range broadly depending on extent and rapidity of obstruction presence of collateral blood flow Prevention healthy lifestyle, diet, and exercise are the key factors in prevention early detection and intervention can reduce severity of symptoms and progression Complications include clot formation development of acute ischemia severe disease may result in distal limb amputation in cases of systemic disease