Leriche syndrome, also referred to as aortoiliac occlusive disease, is complete occlusion of the infrarenal aorta and bilateral common iliac arteries. The development of collateral pathways allows reconstitution of arterial blood flow to the lower extremities, preventing limb ischemia. Patients typically present with a triad of symptoms, which include intermittent claudication of the buttocks and thighs, decreased or absent femoral pulses, and impotence in men. Sonography may play a significant role in diagnosing Leriche syndrome, particularly in cases with contraindications to other more invasive tests. Knowledge of the presentation of aortoiliac occlusion along with recognition of developing collateral pathways assists with the diagnosis and management of this disease.