Aortoiliac Occlusive Disease: Causes, Symptoms, Treatment, Prevention, Diagnosis
What is Aortoiliac Occlusive Disease?
Aortoiliac occlusive disease (also known as AIOD) is a medical condition characterised by blockage of the aorta (which is the most important blood vessel in the body) or the iliac arteries. The iliac arteries are the branches of the aorta which supplies blood to the lower portion of the body including the lower limbs and other organs in the pelvic region. The iliac arteries branches around the level of belly button before supplying the above mentioned areas. It has been seen that the iliac arteries and the aorta are the second most common blood vessels to be affected by peripheral arterial disease; the most commonly affected one being the blood vessels of the thigh. Peripheral arterial disease affects around 12 to 20% of the population aged above 65 years. In medical term it is also known as Lerich’s syndrome or Lerich syndrome. It is characterised by a classical triad of:
- Absence or reduced femoral pulses
- Claudication in the buttock or thigh region
- Erectile dysfunction.
Symptoms of Aortoiliac Occlusive Disease
Symptoms of aortoiliac occlusive disease are varied in nature. Some patients may have multiple symptoms while some may not have any symptoms but still have aortoiliac occlusive disease. The following symptoms are known to be associated with aortoiliac occlusive disease:
Pain and Discomfort along with Cramping while Walking: There may be pain and discomfort in the lower portion of the body associated with generalised fatigue and weakness. The symptoms are mild to moderate when felt over the regions of buttocks, thighs or calves. As the disease progresses, the affected individual may experience pain or cramping after walking for short distances.
Sexual Dysfunction: Some male patients may experience erectile dysfunction which in turn affects their sexual health.
Pain at Rest: The severely progressed cases, one pain experience pain in the lower legs including toes while at rest. There may be sensitivity to temperature changes, coldness or numbness in the lower limbs. In extreme cases, it may be associated with soreness or wounds on legs and feet and even gangrene in some cases, which if left untreated, can lead to tissue death in the feet.
Possible Causes of Aortoiliac Occlusive Disease
The most common causes of aortoiliac occlusive disease are discussed below:
Atherosclerosis: Atherosclerosis (also known as hardening of the arteries) is one of the most common causes of aortoiliac occlusive disease. Atherosclerosis is commonly caused by excessive smoking, high cholesterol, elevated blood pressure, obesity, or genetic inheritance.
Inflammatory Conditions Causing Aortoiliac Occlusive Disease: Some inflammatory conditions such as Takayasu’s arteries may lead to situations which may cause block in the arteries.
Exposure to Radiation: Excessive exposure to radiation may lead to inflammation in the walls of the arteries leading to blockage in them.
Diagnosis of Aortoiliac Occlusive Disease
Aortoiliac occlusive disease is treated by a vascular surgeon. A thorough case history is obtained by a vascular surgeon followed by a physical examination. Diagnostic tests include ankle brachial index test and duplex ultrasound study. In some cases, CT angiogram, MR angiogram or catheter directed angiogram are obtained. Different types are used to detect the severity and location of blockage. In cases of CT or MR angiogram, the dye is delivered through IV mode. In cases of catheter angiogram, the dye in injected using a catheter inserted in an artery.
Treatment and Management of Aortoiliac Occlusive Disease
In most of the cases, the treatment modality includes the following:
- Lowering Blood Pressure and Sugar Levels: Identification of the associated risk factors and controlling the same such as limiting smoking, regulating cholesterol levels, controlling blood pressure, management of diabetes, following a healthy lifestyle and regular exercising. The goal should be to bring down HbA1c level below 7%, and blood pressure lower than 140/90 mmHg.
- Blood Thinners to Reduce Blood Clotting: Prescription of anti-platelet medicines such as Aspirin is often helpful in this condition. It prevents clotting of platelets in the blood. This also helps in regulating cholesterol level and prevents development of plaque. Anti-platelet medicines help in reducing risk of myocardial infarction, vascular death and stroke.
- Minimally Invasive Surgery to Treat Aortoiliac Occlusive Disease: In advanced cases, surgical intervention may be needed. A surgical bypass which is a minimally invasive procedure is often considered if the condition has advanced. This procedure involves placement of a stent in the aorta or the iliac arteries. In most of the cases, the stenting procedure is done at the same time of doing catheter directed angiogram test. In stenting, the stent usually compresses the plaque against the artery walls, thus creating more space for the blood to flow through them. Over a period of time, the plaque gets crushed or gets dissipated. In cases of angioplasty, an inflatable balloon is introduced in the blocked arteries with the help of a catheter which helps in widening the lumen of the artery.
- Surgical Bypass to Treat Aortoiliac Occlusive Disease: Surgical bypass is a procedure, where a detour is created around the blocked vessel. In these cases, a detour is created from the aorta, near the heart to either an artery in the groin or iliac arteries in the pelvis. It may be done unilaterally or bilaterally at the same time. An artificial graft is often used in this procedure. In unfavourable conditions, a bypass may start from the axillary artery underneath the collarbone and end in one or both legs.
In most of the cases, the outcome of the treatment is long lasting and good; but needs follow up at regular intervals. It is advised to follow up every 3 to 6 months for the first year and every 6 to 12 months after that. In cases, where a prosthetic implant has been grafted, a lifelong risk of developing graft infection exists. Besides these, appropriate oral prophylaxis is recommended prior to any dental treatment, sigmoidoscopy, urologic instrumentation or any other gastro-intestinal surgical procedures.
Prevention of Aortoiliac Occlusive Disease
Aortoiliac occlusive disease is associated with unhealthy lifestyle and can be prevented by living a healthy life. Leading an active life with being physically active and regular exercises can help in preventing this condition. Regular physical activity can help in management of increased cholesterol level, elevated blood pressure and increased blood glucose level. Refraining from smoking is also beneficial. It is recommended to enrol in smoking cessation program which can help is quitting smoking if you are unable to do it on your own or if there is a relapse. Besides this, following a healthy balanced diet is also essential. It is recommended to follow a low fat diet.