Leriche\'s syndrome is characterized by chronic obstruction of the abdominal aorta and iliac arteries. A patient with Leriche\'s syndrome presented with twin pregnancy and severe preeclampsia at 32 weeks\' gestation. Cesarean delivery was performed and the patient was admitted to the intensive care unit. Magnetic resonance angiography showed total occlusion of the distal abdominal aorta, common, and external iliac arteries. There were extensive collateral vessels between the lumbar arteries and iliolumbar arteries. The patient was discharged in an improved clinical condition. Leriche\'s syndrome and pregnancy demonstrating complete aortic, common, and external iliac artery occlusion is very rare in the literature. Despite complete occlusion, viability of the fetus can be achieved with collateral vessels.

Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D global cartography of all abdominal arteries and that with only a limited amount of contrast media. MDCTA allows the optimal diagnosis of single or multiple arterial stenosis and easily analyses sometimes very complex collateral pathways. It constitutes a major advance to plan the arterial visceral safety of major commonly performed abdominal surgical procedures such as aorto-iliac surgery, endovascular aneurysm repair (EVAR), but also complex pancreatic and gastrointestinal or colonic surgery. It also allows to plan the most optimal strategy for revascularization of the mesenteric system through percutaneous angioplasty, stent placement or surgical bypass. This extensive pictorial review illustrates a large variety of situations which may be found during clinical practise. Single compression or stenosis of each digestive artery, combined and/or complex associations of stenosis and/or compressions of several arteries, secondary complications like aneurysms and classical but also sometimes unusual patterns of collateralization are richly illustrated. Specific syndromes comprising the median arcuate ligament syndrome (MALS) and the Leriche\'s syndrome are also discussed.

Our goal was to describe a new standardized approach in patients with extensive obliterative arteriopathy aimed at distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass grafting and renal artery revascularization.
Three patients with Leriche\'s syndrome and either a compromised single kidney or unilateral significant renal artery stenosis were treated with a standardized surgical approach, restoration of distal perfusion via descendo-bifemoral bypass with synchronous ( n  = 2) left-sided renal artery revascularization or metachronous ( n  = 1) right-sided renal artery revascularization.
The intended surgical aim was achieved successfully in all 3 cases. All patients showed a decline in serum creatinine levels. One patient who needed substitution therapy was free from dialysis 3 months after surgery. Additionally, blood pressure management was substantially reduced because uncontrolled peak systolic episodes were no longer observed and pharmacotherapeutic agents could be partially withdrawn.
Distal revascularization and surgical kidney recruitment via descendo-bifemoral bypass and renal artery revascularization is a promising option to treat complex obliterative arteriopathy.