Leriche syndrome presents as a triad of claudication, erectile dysfunction, and decreased distal pulses. This syndrome is a well-recognized entity in the current literature; however, our case report illustrates that even with a severe ostial lesion of the inferior mesenteric artery, the vessel was able to provide perfusion to bilateral lower extremities. The patient presented with symptoms of progressive pain in his right leg that limited his physical activity and he also complained of paresthesia, pallor, and cold skin with black discoloration of his toes bilaterally. Diagnostic testing confirmed Leriche syndrome and he successfully underwent surgical revascularization.