Leriche syndrome is defined as a chronic occlusive disease of the infrarenal aorta and the iliac axis. This syndrome slowly progresses proximally and distally overtime, but proximal progression to the suprarenal level is rare. We herein report a patient who presented with Leriche syndrome affecting the bilateral renal artery. A 36-year-old man was admitted to our institution with intermittent claudication and intractable hypertension. A blood chemistry analysis revealed some autoantibodies. A CT scan showed stenosis of the suprarenal aorta and occlusion from the juxtarenal aorta to the bilateral common iliac artery with occlusion of the right renal artery and severe stenosis of the left renal artery. We performed thromboendarterectomy of the juxtarenal aorta and bilateral renal artery under suprarenal aortic cross-clamping and bifurcated graft replacement. Thereafter, his intermittent claudication and hypertension improved. The histological findings showed thrombotic occlusion, while additionally anti-phospholipid antibody syndrome was suspected.

The postoperative course of simple aortic coarctation is favorable, with survival rates at 20, 30, and 40 years of 89%, 82%, and 79%, respectively. However, it is associated with postoperative complications, including postoperative restenosis, aortic aneurysm, aortic dissection, bicuspid aortic valve-associated valve disease, infective endocarditis, coronary artery disease, cerebrovascular accident, and hypertension. This diversity in postoperative complications necessitates long-term follow-up. The patient in the present case underwent aortic coarctation repair through left thoracotomy at another hospital at the age of 9 months. The patient was followed up until 18 years of age but subsequently discontinued follow-up. At age 26 years, the patient was referred to our hospital with a chief complaint of chest pain. Upon examination, we discovered a bicuspid valve-associated aortic insufficiency, an ascending aortic aneurysm, and aortic root dilation. Therefore, we performed Bentall and hemiarch replacement, after which we continued to follow-up the patient at our hospital. At age 37 years, the patient developed an aneurysm in the aortic arch distal to the proximal anastomosis in the initial surgery; therefore, we performed total arch replacement. Despite requiring two surgical interventions after the initial surgery, the patient has demonstrated favorable results. Thus, we report the our findings in this case results here.

EVAR is the first-line treatment for patients with ruptured abdominal aortic aneurysm (rAAA) or iliac artery aneurysm (rIAA) in our hospital. We performed the procedures in 12 patients. Our report describes two hemodynamic stable patients with Fitzgerald classification grade 4 performed with EVAR. Case 1: An 85-year-old unconscious man was admitted to our hospital. We diagnosed him with Fitzgerald grade 4 saccular rIAA. We performed EVAR under local anesthesia with heparin. Although antibiotics were administered to treat pneumonia, the patient was discharged on the 58th day postoperatively. Case 2: A 69-year-old unconscious man was admitted to our hospital. We diagnosed the patient with Fitzgerald grade 4 saccular rAAA. We performed EVAR under general anesthesia and with heparin. The patient was discharged on day 11 postoperatively. No aneurysm-related complications were observed in case 1 or 2, for 3 and 2 years, respectively. EVAR is one of the useful options for hemodynamic stable patients with Fitzgerald grade 4 rIAA and rAAA.