BACKGROUND Leriche's syndrome is defined as atherosclerotic occlusion of the infrarenal aorta and/or the iliac axis. It is associated with claudications or critical limb ischaemia and erectile dysfunction in men. METHODS Twenty patients with Leriche's syndrome were operated on at the Department of Surgery, University Hospital in Pilsen between 2008 and 2012. There were 6 women and 14 men of average age 60.3 years (41-76 years). Three patients were in group C and 17 in group D according to the Trans-Atlantic Inter-Society Classification IIb (TASC IIb). Fifteen patients suffered from chronic claudication or rest pain, five patients had acute limb ischaemic symptomatology. Aortobifemoral bypass with subsequent anti-aggregation therapy was the only treatment option. RESULTS Primary 30-day patency was 100%. 30-day postoperative mortality was 5% (one patient died of acute myocardial infarction). Two patients died in two and four years after the reconstruction (10%) due to cerebral ischaemia and bronchopneumonia. Only one extremity amputation was performed within the five-year interval after vascular reconstruction. All aortobifemoral reconstructions were patent in two months to five years after the operation. We had to manage only one false aneurysm in the groin three years after the aortobifemoral reconstruction. CONCLUSIONS Aortobifemoral bypass is a method of choice for the treatment of Leriche's syndrome. Endovascular treatment is suitable for patients with severe comorbidities.