Issues during coronary and visceral revascularization in patients with leriche syndrome and thoracoabdominal aneurysm

We read with interest the case report of Kitamura et al.1in whichauthors presented consequent coronary revascularization and thor-acoabdominal replacement in a patient with coronary artery disease,thoracoabdominal aneurysm, and Leriche syndrome. We believe themanuscript contains certain issues to be discussed in details.The internal thoracic arteries are among the major blood sup-plies to the lower extremities in case of Leriche syndrome.1,2Theymay dilate to provide sufficient blood flow to the legs.2The dilatationprocess may also be associated with increased risk of atherosclerosisand fragility. When patients with Leriche syndrome requires cor-onary revascularization two concerns arise: