Particularly common in presence of diabetes mellitus or cigarette smoking. Symptoms include intermittent claudication of the buttocks and thighs and impotence (Leriche syndrome); femoral and other distal pulses are absent. Diagnosis is established by noninvasive leg pressure measurements and Doppler velocity analysis, and confirmed by MRI, CT, or aortography. Catheter-based endovascular treatment or aortic-femoral bypass surgery is required for symptomatic treatment or in cases of critical limb ischemia.