A 55-year-old man with Leriche syndrome has bilateral leg claudication, buttock claudication, and erectile dysfunction. Angiography shows complete aortoiliac occlusion. The most appropriate revascularization is:
- A Bilateral iliac angioplasty and stenting
- B Aortobifemoral bypass grafting ✓
- C Axillobifemoral bypass (extra-anatomic)
- D Femoro-femoral crossover graft
Explanation
Leriche syndrome (aortoiliac occlusive disease) causing bilateral claudication, buttock pain, and erectile dysfunction is best treated by aortobifemoral bypass grafting, which provides the most durable revascularization with patency rates of 85–90% at 5 years and 70–80% at 10 years. Endovascular therapy (angioplasty/stenting) is preferred for focal TASC A/B iliac lesions but is not feasible for complete aortoiliac occlusion (TASC D). Axillobifemoral bypass is an extra-anatomic alternative for high-risk surgical patients, with lower patency rates. Femoro-femoral crossover requires a patent donor iliac artery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.