© 2022, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Two-sided atherosclerotic involvement of peripheral arteries is common in clinical practice; however, the data about it in the literature is limited. This study aimed to investigate the frequency, clinical characteristics, and predictors of bilateral symmetric total superficial femoral artery (SFA) occlusions (mirror lesions). Between January 2015 and April 2020, 167 patients with symptomatic total SFA occlusions were retrospectively analyzed. Unilateral and bilateral SFA occlusions were determined, and the risk factors and clinical presentation were investigated between the two groups. Among 167 patients, 95 (57%) had bilateral SFA lesions, and 30 (18%) presented with critical limb ischemia (CLI). In the bilateral SFA occlusion group, male sex was dominant (p=0.002), and peripheral artery disease (PAD) history was higher (p=0.030). Additional iliac lesions (p = 0.003) and below-knee lesions (p <0.001) were more common in the bilateral SFA occlusion group. The sensitivity of Doppler ultrasonography in detecting SFA occlusions was 83.9%. In multivariate logistic regression analysis, younger age (OR; 0.95 CI; 0.91-0.99 p = 0.030) and history of PAD (OR; 2.08 CI; 1.02-4, 24 p = 0.040) were identified as independent markers for predicting mirror SFA occlusions Our study demonstrates that the mirror lesion pattern is common in patients with symptomatic SFA total occlusion. Thus, the non-index leg evaluation should be recommended. The younger the age, and PAD history were the predictors of mirror total SFA occlusions.