A successful case of revascularization with a hybrid intervention for Leriche syndrome combined with bilateral femoropopliteal occlusive disease.

Leriche syndrome (LS) is an aortoiliac occlusive disease (AIOD) characterized by claudication, decreased femoral pulses, and erectile dysfunction. We present an LS case with bilateral femoropopliteal occlusive disease (FPOD) considered untreatable with surgery or endovascular therapy alone but successfully revascularized via hybrid intervention (HI). An 84-year-old woman with a history of LS was admitted to our hospital with rest pain in the right leg, and coldness and numbness in the left leg. The ankle-brachial index (ABI) indicated severe bilateral amplitude reduction and pulse elongation. Computed tomography angiography revealed occlusion of the terminal aorta, bilateral common iliac artery to external iliac artery, common femoral artery to superficial femoral artery, and right popliteal artery with poor run-off. We initially decided to perform HI only on the right lower extremity. Easy guidewire passage through the occluded lesion suggested a primarily thrombotic nature. HI using Fogarty arterial thrombectomy was eventually performed for the bilateral lower extremities. Complete revascularization was achieved using covered and self-expanding stents for aortoiliac lesions, and drug-eluting stent deployment and drug-coated balloon angioplasty for FPOD. The post-operative ABI was elevated, and symptoms improved bilaterally. This HI is highly effective for treating AIOD combined with bilateral FPOD involving thrombotic lesions. Learning objective: Aortoiliac occlusive disease (AIOD) with bilateral femoropopliteal occlusive disease was considered difficult to treat with surgery or endovascular therapy (EVT) alone. Hybrid interventions are ideal for patients with AIOD with extension to the common femoral artery or superficial femoral artery, especially involving thrombotic lesions. This procedure achieves good results that cannot be obtained by surgery or EVT alone.