Aortoiliac Occlusive Disease is the blockage of the aorta and/or iliac arteries. The iliac arteries branch off the aorta at the level of the belly button and provide blood to your legs and organs in your pelvis. The blockage is typically caused by atherosclerosis or a buildup of plaque in the walls of your blood vessels. The aorta and iliac arteries are the second most common blood vessels to be affected by peripheral artery disease (PAD) after the blood vessels in the thigh. Individuals with PAD may have other systemic atherosclerotic problems such as coronary artery disease, cerebrovascular disease, and renal insufficiency.
Lower extremity PAD is the most common type. PAD can increase the risk of heart attack, stroke or even death if left untreated. Early diagnosis and treatment can help slow down the progression of PAD, prevent complications and improve your quality of life. For most individuals with PAD, symptoms may be mild or absent, and no treatment is needed. However, as these blockages become more widespread you may be at risk for limb loss. Improving blood flow to the limb can help reduce pain, improve functional ability, quality of life and prevent amputation.
Risk Factors
Older age, smoking, hypertension, male sex, diabetes, hyperlipidemia, obesity, family history of Atherosclerosis, hyperglycemia, high triglycerides
Clinical Presentation
PAD patients often have no symptoms. PAD can present with pain in the lower extremities related to activity (intermittent claudication). In more advanced disease, patients may experience rest pain, non-healing wounds or gangrene
Diagnosis
Ankle-Brachial Index (ABI), Duplex Ultrasound and if further testing is needed a CTA, MRA or catheter directed angiogram may be performed.
Treatment
Treatment depends on the severity of your condition. In some cases, lifestyle changes and medications can help manage your condition and slow down its progression.
Lifestyle modifications such as smoking cessation, eating healthy and increasing physical activity, controlling cholesterol or high blood pressure and managing diabetes can improve outcomes. In addition to lifestyle modifications, medication may be prescribed, such as antiplatelet, anticoagulant, statin and blood pressure lowering medications.
The most common minimally invasive treatment used to treat aortoiliac disease is balloon angioplasty with stent placement. This procedure uses a balloon to open the artery where a metal mesh tube (stent) is deployed to hold the artery open, allowing blood to flow through the vessel. Your physician may perform bypass surgery if you have large arterial blockages and severe symptoms, or if you have already failed a prior angioplasty attempt. A surgical bypass is the creation of a detour around the blockage. The detour may start in the aorta and may end either in the iliac arteries in your pelvis or an artery in your groin. A bypass may be performed either on one or both sides at the same time.