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Objectives: Leriche syndrome, defined as a chronic obliteration of a segment of the infrarenal aorta and the iliac arteries, represents a challenging pathology. Surgical reconstruction represents the standard treatment option. However, the endovascular therapy is gaining ever greater applicability in several vascular territories comparable with the open repair results. The aim of the present study was to evaluate the role of endovascular repair in patients with chronic Leriche syndrome. Methods: Between January 2008 and September 2016, 82 patients with Leriche syndrome underwent surgical and endovascular repair at two European vascular centers. After risk stratification, 40 patients were matched based on chronic TASC D obstructive arterial disease with involvement of the aortic bifurcation and bilateral iliac arteries, the age, and the cardiovascular risk factors identifying finally 20 patients who underwent surgical repair (open group) and 20 patients who were treated by deployment of stents/stent-grafts in the aortic and iliac segment (endo group). Kaplan–Meier estimation for patency and freedom from reintervention were calculated and univariate analyses were performed. Results: Estimated primary patency rate was 100% vs. 84% at one year for the open group vs. endovascular group, respectively (p =.05). Freedom from reintervention was 100% vs. 89% at one year for the open group vs. endo group (p =.09). During the entire follow-up of 34.9 ± 23.1 months, five reinterventions were performed for the endo group vs. two for the open group (p =.212). Additionally, the major adverse cardiac and cerebrovascular events were 5/20 vs. 2/20 for the endovascular vs. open group, respectively (p =.212). The postoperative ankle–brachial index improved in 0.66 in the endo group vs. 0.71 in the open group (p =.624). Conclusions: Endovascular techniques for the treatment of complex chronic Leriche lesions seem not to be associated with better early or mid-term outcomes compared to surgical repair. [ABSTRACT FROM AUTHOR]