Aortoiliac occlusive disease
In medicine, aortoiliac occlusive disease is a form of central artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries.
Signs and symptoms
Classically, it is described in male patients as a triad of the following signs and symptoms:- claudication of the buttocks and thighs
- absent or decreased femoral pulses
- erectile dysfunction
Diagnosis
The physical examination usually shows weakened femoral pulses and a reduced ankle-brachial index. The diagnosis can be verified by color duplex scanning, which reveals either a peak systolic velocity ratio ≥2.5 at the site of stenosis and/or a monophasic waveform. MRA and multidetector CTA are often used to determine the extent and type of obstruction. Another technique is digital subtraction angiography which allows verification of the diagnosis and endovascular treatment in a single session.Angiography provides important information regarding the perfusion and patency of distal arteries. The presence of collateral arteries in the pelvic and groin area is important in maintaining crucial blood flow and lower limb viability. However, angiography should only be used if symptoms warrant surgical intervention.
Treatment
Treatment involves revascularization typically using either angioplasty or a type of vascular bypass- Kissing balloon angioplasty +/- stent, so named because the two common iliac stents touch each other in the distal aorta.
- Aorto-iliac bypass graft
- Axillary-bi-femoral and femoral-femoral bypass