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Aortoiliac Disease
 

Basic Facts

  • Aortoiliac occlusive disease is the narrowing or blockage of the main arteries in the pelvis, which supply blood to the legs. It is a type of peripheral arterial disease, or PAD, which affects arteries that carry blood away from the heart to the head, torso, arms, and legs.
  • Aortoiliac disease can prevent blood from reaching parts of the buttocks, groin, legs and feet. A lack of blood can cause discomfort or weakness in the hips or legs while walking, sores on the legs, feet, and toes, known as ulcers, and even gangrene.
  • The most common symptom of aortoiliac disease is a discomfort in the legs during activity, called intermittent claudication.
  • Male patients with aortoiliac disease often experience erectile dysfunction.
Aortoiliac disease, also called aortoiliac occlusive disease, refers to disorders of the two major blood vessels that feed the lower half of the body?the aorta and the iliac artery.

Aortoiliac disease occurs in one or more of the following locations:
  • The lower abdominal aorta;
  • The iliac arteries; or
  • The point where the aorta divides and becomes the iliac arteries.
Impaired circulation in these arteries can result in disorders of the pelvic organs, legs, or the kidneys, which causes a condition called renal artery disease. Additionally, aortoiliac disease can result in an aortic abdominal aneurysm (AAA), a dangerous health condition.

CAUSES AND RISK FACTORS

The primary cause of aortoiliac disease is atherosclerosis, or hardening of the arteries.

Risk factors for atherosclerosis include:
  • Smoking;
  • High blood pressure, or hypertension;
  • Obesity;
  • High cholesterol or hyperlipidemia; and
  • A family history of cardiovascular disease.
WHAT ARE THE SYMPTOMS?

The primary symptoms of aortoiliac disease are pain, cramping, or tiredness (called intermittent claudication), which occur when a person walks or exercises. Male patients with aortoiliac disease also often experience erectile dysfunction.

Eventually, severe symptoms can occur in the lower extremities, including:
  • Severe pain, coldness, and numbness in a limb;
  • Sores on the toes, heels, or lower leg (called ulcers);
  • Muscle atrophy (wasting); and
  • Gangrene (tissue death).
Symptoms of renal artery disease include:
  • Hypertension;
  • Symptoms of kidney failure; and
  • An abnormal sound or murmur, called a bruit.
Most people with AAA do not feel any symptoms. Others, however, may experience symptoms including:
  • A rhythmic, pulsating feeling in the abdomen, similar to a heartbeat;
  • Deep pain in the abdomen or lower back; and
  • Severe, sudden abdominal or back pain, which may indicate imminent rupture.
Patients with a ruptured abdominal aortic aneurysm, which requires immediate emergency medical attention, usually feel sudden and intense weakness, dizziness, or pain, and may lose consciousness.

DIAGNOSIS

The physician will perform tests to diagnose aortoiliac disease, including:
  • Pulse tests;
  • Blood pressure testing;
  • Duplex ultrasound; and
  • Angiography.
TREATMENT APPROACH

Treatment for mild to moderate aortoiliac disease focuses on lifestyle modifications, supportive care, and medications.

Lifestyle modifications include:
  • Quitting smoking;
  • Maintaining a healthy body weight;
  • Eating a lowfat, high-fiber diet; and
  • Exercising regularly.
Supportive care includes:
  • Learning the basics of foot hygiene;
  • Wearing protective, well-fitting, and cushioned footwear;
  • Avoiding foot trauma; and
  • Receiving ongoing foot care.
Medications the physician may prescribe include:
  • Cilostazol (Pletal); and
  • Aspirin or clopidogrel (Plavix).
For patients with renal hypertension, the physician may also prescribe antihypertensive medications.

For severe aortoiliac disease, treatment may include minimally invasive procedures or surgery, including:
  • Angioplasty and stenting;
  • Atherectomy catheterization; and
  • Bypass surgery.
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