Aorto Iliac Occlusive Disease

What is an aortoiliac occlusive disease?

Aortoiliac occlusive disease is the blockage of the aorta, the main blood vessel in your body, or the iliac arteries. The iliac arteries are the branches that your aorta divides into around the level of the belly button to provide blood to your legs and the organs in your pelvis. This blockage is typically caused by a buildup of plaque within the walls of your blood vessels.

The aorta and iliac arteries are the second most common blood vessels to be affected by peripheral arterial disease (PAD) after the blood vessels in the thigh. PAD occurs in 12-20% of people over the age of 65.

What are the symptoms of aortoiliac occlusive disease?

No symptoms may be present

• You may have varied symptoms or no symptoms at all and still have aortoiliac occlusive disease.

Fatigue, pain or cramping when walking

• When felt in the buttocks, thighs or calves, these symptoms may signal mild to moderate aortoiliac occlusive disease. As the disease progresses, these symptoms may occur after walking very short distances.

Erectile Dysfunction

• Men may experience erectile dysfunction.

Pain at rest, leg and foot problems

• In severe cases, you may feel pain in your feet or toes at rest, coldness and numbness in your legs, sores or wounds on your legs and feet, and even gangrene or the death of tissue in your feet.

What causes blockage of the aorta?

• The most common cause of aortoiliac disease is atherosclerosis (hardening of the arteries). Hardening of the arteries may be caused by smoking, high cholesterol, high blood pressure, genetic predisposition or obesity.
• Inflammatory conditions such as Takayasu’s arteritis may cause inflammation in the arteries causing blockages of the arteries.
• Radiation to the pelvis may cause progressive inflammation in the arterial wall leading to blockages of the arteries.

How is this problem diagnosed?

• Step one is a history and physical by a trained vascular surgeon.
• Initially an ankle-brachial index test and a duplex ultrasound may be recommended.
• If further testing is needed a CT angiogram, MR angiogram, or a catheter-directed angiogram are options. These studies use different types of dye to help identify where blockages in the arteries are located to plan further treatment. With a CT angiogram and MR angiogram, dye is delivered through an IV. With a catheter-directed angiogram, dye is injected through a thin tube (catheter) inserted in an artery.

Treatment strategies

Aortoiliac occlusive disease may be managed by:

• Risk factor modification, such as quitting smoking, controlling cholesterol or high blood pressure, managing diabetes and regular exercise.
• Medication may be prescribed, such as an aspirin or another medication to prevent platelets from clotting in the blood. A statin drug may help control cholesterol and also help prevent plaque progression.

If further treatment is needed, a minimally invasive procedure or a surgical bypass may be considered.

• The most common minimally invasive treatment is the placement of a stent in your aorta or iliac arteries. The stent is a small device that compacts the plaque against the walls of the arteries to create a wider path for blood flow to the lower half of your body. An angioplasty, in which an inflatable balloon device is inserted through the catheter to further assist in opening up the arteries, can be added to the treatment.
• Surgical bypass creates a new arterial path around the blockage. The route of the new artery may follow the existing pathway of the blockage but occasionally it is necessary to route the bypass away from the typical anatomic planes- an extra anatomic bypass- coming off the auxiliary artery in the shoulder.