As you age, it is not uncommon for plaque (a gummy substance made of cholesterol, calcium, and fibrous tissue) to build up on the inside of artery walls. As more plaque accumulates, the arteries begin to narrow and stiffen causing atherosclerosis, or hardening of the arteries. When enough plaque builds up to interfere with blood flow, it is called aortoiliac occlusive disease.
Reduced blood flow to the legs can lead to a condition called ischemia. When blood flow is reduced, the legs do not receive enough oxygen, which can cause pain. If left untreated, ischemia can become severe and lead to sores or gangrene, and even the loss of a limb.
Symptoms of Aortoiliac Occlusive Disease
At the onset of aortoiliac occlusive disease, you may experience mild symptoms such as pain, cramps, or fatigue in your lower body during physical exertion, like walking or exercising. This pain usually presents in the calves, thighs, and buttocks. Early in the disease process, these symptoms will stop when the legs are at rest. As the disease progresses, the pain will extend down the legs and will occur during light exercise or even while resting.
Male patients may also suffer from erectile dysfunction as a result of aortoiliac occlusive disease.
If not treated, aortoiliac occlusive disease can worsen. Signs of advanced aortoiliac occlusive disease include:
- Extreme pain affecting one or both legs
- Coldness or numbness in the legs
- Sores on the lower legs, heels, and/or toes
- Severely dry, scaly, or cracked skin on the feet
- Weak muscles in the legs
- Gangrene, or tissue death (may lead to loss of limb if left untreated)
- Pain in the calves or buttock when walking
Causes & Risk Factors
The main cause of aortoiliac occlusive disease is atherosclerosis, or hardening of the arteries. In rare instances, primary disease of arteries or connective tissue diseases can cause aortoiliac occlusive disease.
Risk factors for developing atherosclerosis include:
- High cholesterol
- High blood pressure
- Family history of heart disease
Tests Used to Diagnose Aortoiliac Occlusive DiseaseIf your doctor suspects that you have aortoiliac occlusive disease, he or she will seek a diagnosis by surveying your general health, inquiring about your medical history and possible risk factors, and asking you to describe your symptoms and how often they occur. This discussion is typically followed by a physical exam, which will most likely include a pulse test (checking various pulse points in the legs for weak or absent pulses).
If these tests indicate that aortoiliac occlusive disease is likely, further tests are needed to determine a firm diagnosis and to learn how much the disease has advanced. The most common diagnostic procedures include:
A Doppler ultrasound uses high-frequency sound waves and a computer to create images of blood vessels to assess the blood flow within the vessels and the structure of the vessels themselves. This is a painless, non-invasive procedure that uses no radiation and can help determine the exact arteries that are affected.
Ankle-Brachial Index (ABI)
An ABI is essentially a comparison of the blood pressure in your arm and the blood pressure in your ankle. A ratio of these two measurements can evaluate how well blood is circulating within your legs.
Your doctor may perform one of three types of arteriography to further determine the location and extent of the damage. Arteriography helps to provide a more detailed roadmap as to where possible aortoiliac occlusive disease is located.
MR Angiography (MRA) and CT Angiography (CTA) – MRA and CTA are imaging procedures that combine X-rays and computer technology to produce detailed images of the blood vessels. Typically, MRA takes longer to perform than CTA. However, unlike CTA, it does not use radiation, so doctors commonly favor MRA for repeated follow-ups.
Contrast Arteriography (Arteriogram) – This is an invasive procedure that provides a more detailed view of the blood vessels and can determine the specific location of blockages. When performing an angiogram, a special dye (properly referred to as contrast) is injected into the blood vessels through a catheter, making arteries visible on an X-ray. During contrast arteriography, it is not uncommon for procedures such as angioplasty or stent repairs to be performed as well.
Treatments for Aortoiliac Occlusive DiseaseTreatment of aortoiliac occlusive disease may include surgery and/or management of risk factors that can cause the disease to worsen. Your doctor will determine the extent of damage to your arteries and examine the blockage patterns to choose the treatment that’s right for you.
The management of aortoiliac occlusive disease often includes modifying your lifestyle to reduce risk factors and possible complications. If you smoke, the most worthwhile lifestyle change you can make is to quit. Your arteries may obtain further damage from the chemicals in tobacco, and your risk of complications from the disease may increase.
It is also important to stay active and exercise if possible. Eating a healthy, low-fat and high-fiber diet along with regular activity will help you maintain a normal weight. Simple lifestyle changes to diet and exercise may slow atherosclerosis.
If you have high cholesterol or high blood pressure, your doctor may prescribe medications to maintain normal levels and reduce the risk of developing complications from the disease.
If you have diabetes, it is important to follow the diet your doctor recommends and to take any medications prescribed to help manage blood sugar levels. Additionally, diabetes may cause a condition called neuropathy, which causes impaired sensation in your feet. If neuropathy develops, it is crucial to care for your feet regularly to avoid developing sores that won’t heal.
Since exercise is an important component in the management of aortoiliac occlusive disease, it is essential to be able to walk without pain. In order to increase the distance that you can walk pain-free, your doctor may prescribe cilostazol (Pletal). It is important to note that this medication cannot be prescribed to patients with medical conditions such as heart failure. To lower your risk of developing blood clots, your doctor may prescribe blood thinners such as aspirin or clopidogrel (Plavix). These medications may help to manage some of your symptoms and may help keep the disease from advancing. However they are not a cure for aortoiliac occlusive disease.
If your aortoiliac occlusive disease is severe, surgery may be necessary. The three primary surgical options include angioplasty, bypass surgery, and endarterectomy.
Angioplasty – An angioplasty is a minimally invasive procedure that helps improve the circulation in your legs. During an angioplasty, a hollow needle will be inserted into your artery and a special balloon attached to a catheter will be threaded through the needle to reach the blockage within the blood vessel. Once this device reaches the desired location, the balloon is then repeatedly inflated and deflated to widen the artery walls. In some cases, a permanent stent (a tube made of mesh and metal) is placed into the narrowed area of the artery to keep it open and allow for unobstructed blood flow.
Bypass – For extensive blockages, a more invasive procedure called bypass surgery may be required. In bypass surgery, a graft (a Y-shaped tube made of synthetic fabric) is inserted into the aorta above the diseased portion of the artery and then attached to the iliac arteries. This creates a detour around the blockages and restores blood flow to the legs. The long-term success of bypass surgery can extend 10 years or more.
Endarterectomy – An endarterectomy is a procedure used to remove plaque buildup on the artery walls, which can restore blood flow to the legs. During the procedure, your vascular surgeon opens the affected artery to remove the plaque buildup on the arterial lining and then repairs the artery with a stitch or graft.
Hybrid Approaches – Hybrid surgical approaches to aortoiliac occlusive disease use combinations of angioplasty and endarterectomy to alleviate obstructions in aortoiliac occlusive disease. These procedures allow for extensive areas of disease to be treated in a minimally invasive way. In this way, patients will have fewer incisions and less postoperative pain while still achieving a durable repair of aortoiliac occlusive disease.