Aortoiliac Occlusive Disease

What is Aortoiliac Occlusive Disease?

Aortoiliac occlusive disease affects the iliac arteries. The iliac arteries split off the aorta around the area of the belly button. The iliac arteries run through the pelvis and down into the legs then divide into smaller arteries that run down to the toes.

Aortoiliac occlusive disease occurs when these arteries harden and narrow as a result of plaque buildup. Plaque is made up of cholesterol, calcium, and fibrous tissue. This stiffening process is called atherosclerosis, or hardening of the arteries. When enough plaque builds and interferes 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.

At Yale Vascular Surgery, we offer the widest range of treatment and management options for aortoiliac occlusive disease. In addition to being well-versed with the traditional or classic techniques and surgeries, many additional procedures offered by our innovative surgeons are at the leading edge of vascular surgery. Our multidisciplinary vascular team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs. 

Causes of Aortoiliac Occlusive Disease

The main cause of advanced aortoiliac occlusive disease is atherosclerosis. In rare cases, a condition known as Takayasu’s arteritis may cause blockages in the aorta and its branches.

Symptoms of Aortoiliac Occlusive Disease

Symptoms of aortoiliac occlusive disease may include pain, cramping, or fatigue in the lower body while walking or exercising. The pain usually occurs in the buttocks, thighs, and legs. Early in the disease, these symptoms will stop when the legs are at rest. As the disease worsens, pain may occur even while resting.

Some men who have aortoiliac occlusive disease also experience erectile dysfunction. 

Signs of advanced aortoiliac occlusive disease include:
  • Severe pain, coldness, and numbness in a limb
  • Sores on your toes, heels, or lower legs
  • Dry, scaly, cracked skin on your foot. 
  • Weakened muscles in your legs
  • Gangrene (tissue death)
Advanced symptoms usually indicate that more than one artery in the leg is blocked. 

Having one or more of the above symptoms does not mean that you have aortoiliac occlusive disease. This list should be used as a guideline only. If you are experiencing one or more of the above symptoms, please call your doctor.

Risk Factors of Aortoiliac Occlusive Disease

At Yale Vascular Surgery, we emphasize patient education, risk-factor reduction, and management. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing certain behaviors and being clinically monitored for the disease.

Risk factors for developing atherosclerosis, which is the main cause of aortoiliac occlusive disease, include:
  • Smoking
  • High cholesterol levels in the blood
  • High blood pressure
  • Obesity
  • Having a family history of heart disease
It is important to understand that having one or more risk factors does not mean that you will develop the disease. The information should be used only as a guideline. 

Diagnosing Aortoiliac Occlusive Disease

If you think you have aortoiliac occlusive disease, it is important to get a diagnosis so that you can begin treatment and management of the disease to prevent further problems.

Yale Vascular Surgery uses the most innovative techniques to diagnose vascular conditions so that you can receive a timely and accurate diagnosis. In addition to using diagnostic procedures, our surgeons take the time to discuss your medical history and perform a physical examination.

Below describes the most common diagnostic procedures: 

Ankle/Brachial Index (ABI)
An ankle/brachial index compares blood pressure measurements taken in the lower leg with those taken in the arm. 

Pulse Volume Recording (PVR)
A pulse volume recording measures the blood volume changes that occur in the legs. In order to get the measurement, blood pressure cuffs are placed on the arm and leg and inflated while the patient is lying down. Then, the pressure in the cuffs is decreased and the patient walks on a treadmill until their leg pain develops. The blood pressure cuff measures the blood flow and a recording device displays the pulse volume differences as a waveform on a monitor. 

An ultrasound uses high-frequency sound waves and a computer to create images of blood vessels and to assess the blood flow within the vessels. 

Arteriogram (Angiogram)
An arteriogram is an X-ray image of the blood vessels. A dye is injected into the artery through a thin, flexible tube. This dye makes the blood vessels visible on the X-ray.

Computed Tomography (CT) Scan
A CT scan is an imaging procedure combining X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of the blood vessels.

Treatment of Aortoiliac Occlusive Disease

Treatment of aortoiliac occlusive disease may include management of risk factors that may cause the disease to worsen and/or surgery.

At Yale Vascular Surgery, our team includes nationally renowned surgeons who are dedicated to helping patients affected by vascular disease and who have continually excelled in caring for patients with aortoiliac occlusive disease. They will help determine the best-possible comprehensive treatment by using the latest technology and compassionate care.

Should you require surgery, our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after the surgery. 

Management of Aortoiliac Occlusive Disease
The management of aortoiliac occlusive disease may include modifying outstanding risk factors, such as quitting smoking or changing your diet, and medications that can control possible risk factors, such as high blood pressure. 

Surgery for Aortoiliac Occlusive Disease
When surgery is necessary, the three primary options include angioplasty, bypass surgery, and endarterectomy. 

An angioplasty is a minimally invasive procedure that helps improve the circulation in your legs. During an angioplasty, a long, thin, flexible tube, called a catheter, is inserted into a small incision. The catheter is guided through your arteries to the blocked area(s). Once there, a special balloon attached to the catheter is inflated and deflated several times in order to widen the artery walls. In some cases, a tiny stent (a mesh-metal tube) is placed into the narrowed area of the artery to keep it open. 

For more extensive blockages, bypass surgery may be required. 
In bypass surgery, a Y-shaped tube made of synthetic fabric, called a graft, is attached to the aorta above the blockage to create a detour around the narrowed or blocked sections of the artery. 

An endarterectomy is a procedure used to remove plaque buildup on the artery walls. This procedure may be done under local or general anesthesia. The surgeon opens the affected artery to remove the plaque buildup and then repairs the artery with a stitch or graft.