In ankylosing spondylitis (AS), the axial skeleton, peripheral joints, and extra-articular structures are also frequently involved. Cutaneous lesions and vasculitis is extremely rare. Lumbar sympathectomy has a definite role in patients with painful cutaneous vasculitis and ischemic leg ulcer, especially those refractory to medical management. Despite the relatively small percentage of patients suffering from chronic leg ulcer, it has a significant impact on the patient's quality of life. A 44-year-old male AS patient with low backache (LBA) of 15 years and bilateral leg pain came to us. But in the past 2 years, severity of pain worsened resulting in infection and ulcer of dorsum of both feet. Examination confirmed multiple ulcers along with sensory loss on the dorsum of foot bilaterally. Not only he was refractory to conventional medical management, but he also had developed various side effects. Our results of diagnostic left lumbar sympathetic block (LSB) turned out to be positive. Next day, radiofrequency ablation (RFA) of lumbar sympathetic chain bilaterally at L2, L3, and L5 was done, and the patient was discharged pain free. At the 3-month review, the leg ulcers had healed, and the patient was pain free. So here, we discuss about the possible mechanisms and the role of LSB in vasculitic leg ulcers.