MetroHealth Heart & Vascular Center
Evaluation and Management of Vascular Disorders
MetroHealth's Vascular Department is committed to
providing the highest level of care to our patients utilizing state of the art
digital technology for the diagnosis of cardiovascular disease. The Non-Invasive
Vascular Laboratory is certified by ICAVL, an independent national accreditation
society, which assures a high quality of patient care by providing a mechanism
to encourage and recognize the provision of quality vascular diagnostic
evaluations by a process of voluntary accreditation. The Vascular Department
offers state of the art of diagnostic and therapeutic procedures for the
diagnosis and treatment of patients with vascular disease.
The Vascular Department offers evaluation and management of vascular
- Peripheral vascular disease
- Aortoiliac disease
- Carotid artery disease
- Aortic aneurysm
What is Peripheral Vascular Disease?
Your arteries are normally smooth and unobstructed on the inside but they can
become blocked through a process called atherosclerosis, which means hardening
of the arteries. As you age, a sticky substance called plaque can build up in
the walls of your arteries.
Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque
builds up, your arteries can narrow and stiffen.
Eventually, as the process progresses, your blood vessels can no longer
supply the oxygen demands of your organs or muscles and symptoms may
Blockages may involve:
- Carotid Arteries
- located on each side of your neck and extend from your aorta in your chest
to the base of your skull. These arteries supply blood to your brain.
- Arm Arteries
- Renal Arteries
- Leg Arteries
- Aortoiliac - the aorta, your body's main artery, splits
into branches at about the level of your belly button. These branches are
called the iliac arteries. The iliac arteries go through your pelvis into your
legs, where they divide into many smaller arteries that run down to your
What is aortoiliac occlusive disease?
• Aortoiliac occlusive disease occurs when your iliac arteries become
narrowed or blocked.
• The iliac arteries go through your pelvis into your legs, where they
divide into many smaller arteries that run down to your toes.
• Aortoiliac disease is considered a type of peripheral arterial disease
(PAD), because it affects arteries that carry blood away from your heart to your
• Your arteries are normally smooth and unobstructed on the inside, but
as you age, a sticky substance called plaque can build up in the walls of your
• Plaque is made up of cholesterol, calcium, and fibrous tissue. As more
plaque builds up, it causes your arteries to narrow and stiffen. This process is
called atherosclerosis, or hardening of the arteries. Eventually, enough plaque
builds up to interfere with blood flow in your iliac arteries or leg arteries.
• Physicians call this aortoiliac occlusive disease.
• When your iliac arteries narrow or become blocked, your legs may not
receive the blood and oxygen they need.
• This lack of oxygen is called ischemia and it can cause pain.
• In severe cases, sores or gangrene can develop, which can result in
you losing a limb. However, these symptoms are uncommon.
What are the symptoms of Aortoiliac Occlusive Disease?
• Early in the disease, you may feel pain, cramping, or fatigue in your
lower body when you walk or exercise.
• The pain with walking usually occurs in your buttocks, thighs, and
• This symptom is called intermittent claudication because it stops when
• As the disease worsens, you may find that pain occurs when you walk
for shorter distances. Ultimately, you may feel pain, usually in your toes or
feet, even when you are resting.
• Some men who have aortoiliac occlusive disease also experience
erectile dysfunction, the inability to have or maintain an erection.
• Aortoiliac disease may worsen if it is not treated.
• Signs that it has advanced include:
- Severe pain, coldness, and numbness in a limb
- Sores on your toes, heels, or lower legs
- Dry, scaly, cracked skin on your foot. Major cracks,
or fissures, may become infected if left untreated
- Weakened muscles in your legs
- Gangrene (tissue death), which may require amputation
- If you experience any of these advanced symptoms, it usually means that
your leg arteries are blocked in more than one place. Your physician may need
to treat more than one site to prevent gangrene or limb loss.
What causes aortoiliac occlusive disease?
• Atherosclerosis, or hardening of the arteries, causes most cases of
aortoiliac occlusive disease.
• Risk factors for hardening of the arteries
- High cholesterol
- High blood pressure
- Having a family history of heart disease
• In rare cases, a condition known as Takayasu’s
arteritis may cause blockages in your aorta and its branches.
Takayasu’s arteritis usually affects young Asian women between the ages of 10
What tests will I need?
• First your physician asks you questions about your general health,
medical history, and symptoms. In addition, your physician conducts a physical
exam. As part of your history and exam, your physician will ask you if you smoke
or have high blood pressure.
• Your physician will also want to know when your symptoms occur and how
often. A pulse examination that checks your pulse in several places in
your legs for weak or absent pulses is part of your physical exam.
• For this test, your physician will simply place his or her fingers
over pulse points.
• After the history and exam, if your physician suspects you may have
aortoiliac disease, he or she will perform tests, such as:
- Ankle-brachial index (ABI): For the ABI, your physician measures your blood pressure
in your ankle and in your arm. Your physician will compare the
two numbers to determine your ABI. Normally, the blood pressures in your
ankle and arm should be about equal. But if your ankle pressure is half
your arm pressure (or lower), your leg arteries are probably narrowed. To
perform the ABI, your physician will use an ordinary blood pressure cuff
and an ultrasound device. The ABI helps your physician diagnose
aortoiliac disease, but it does not identify which arteries are blocked.
- Doppler ultrasound: Doppler ultrasound uses high-frequency sound waves
that bounce off of blood cells and blood vessels to show blood
flow and problems with the structure of blood vessels. This test
identifies specific arteries that are blocked.
- Angiogram: In this test, your physician injects a
contrast dye into your arteries and then takes x rays. The structure of
your arteries appears on the x ray because x rays cannot
pass through the dye. This test finds the exact location and pattern of
How is aortoiliac occlusive disease treated?
• In mild to moderate cases, your physician may recommend that you
change certain aspects of your lifestyle.
• If you are a smoker, the most important step you can take is to quit
smoking. Chemicals in tobacco can damage your arteries. These chemicals can also
increase your chance of having complications from aortoiliac occlusive
• In addition to quitting smoking, your physician may recommend that you
maintain a healthy weight, follow a structured walking program at least 3 or 4
times a week, and eat a low-fat and high-fiber diet. These changes help slow
hardening of the arteries.
• If you have diabetes, you need to control your blood sugar levels. If
necessary, your physician may prescribe medications to lower high cholesterol
and high blood pressure.
• If you have diabetes, your physician may recommend that you receive
foot care from a qualified healthcare professional and learn the basics of
caring for your feet at home. This includes practicing foot hygiene, wearing
protective, well fitting, and cushioned footwear, and avoiding injuries to your
foot. This type of care can be very important because you can lose feeling in
your feet and develop sores on them.
• If you do not have a disqualifying medical condition, such as heart
failure, your physician may also prescribe cilostazol (Pletal), which can
improve the distance you are able to walk without pain.
• Other drugs your physician may prescribe include aspirin or
clopidogrel (Plavix), either of which can lower your chances of blood clots.
Angioplasty or Surgery
• If you have severe aortoiliac occlusive disease, particularly if it
does not improve with the measures described above, your physician may recommend
surgery or a minimally invasive treatment called angioplasty to improve the
circulation in your legs.
• The choice of the treatment depends upon
the pattern and extent of the blockages.
• In an angioplasty, a long, thin, flexible tube called a catheter is
inserted into a small puncture over an artery in your leg and is guided through
your arteries to the blocked area.
• Once there, a special balloon attached to the catheter is inflated and
deflated several times.
• The balloon pushes the plaque in your artery against your artery
walls, widening the vessel.
• A tiny mesh-metal tube called a stent may then be placed into the
narrowed area of your artery to keep it open. The stent remains permanently in
your artery. After successful angioplasty, blood flows more freely through your
• Bypass surgery creates a detour around the narrowed or blocked
sections of your artery. (for more information about peripheral arterial bypass
surgery click here)
• A Y-shaped tube made of synthetic fabric, called a graft, is attached
to your aorta above the blockage.
• The two branches of the graft are then attached to either your left
and right iliac arteries or other major arteries in each leg (called the femoral
• Bypass surgery restores blood flow to the lower extremities. Results
are commonly maintained for 10 or more years in about 85 percent of patients.
• An endarterectomy is a way for your surgeon to remove the plaque from
• To perform an endarterectomy, your vascular surgeon makes an incision
in your leg and removes the plaque contained in the inner lining of the diseased
• This leaves a wide-open artery and restores blood flow through your