What Is Aortoiliac Occlusive Disease ?
Aortoiliac occlusive disease occurs when your iliac arteries become narrowed or blocked. The aorta, your body's main artery, splits into branches at about the level of your belly button. These branches are called the iliac arteries. The iliac arteries go through your pelvis into your legs, where they divide into many smaller arteries that run down to your toes. Aortoiliac disease is considered a type of peripheral arterial disease (PAD) because it affects arteries, which are blood vessels that carry blood away from your heart to your limbs.
Your arteries are normally smooth and unobstructed on the inside, but as you age, a sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, it causes your arteries to narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to interfere with blood flow in your iliac arteries or leg arteries. Physicians call this aortoiliac occlusive disease because it involves the aortoiliac arteries.
What Are The Symptoms ?
Early in the disease, you may feel pain, cramping, or fatigue in your lower body when you walk or exercise. The pain with walking usually occurs in your buttocks, thighs, and legs. This symptom is called intermittent claudication because it stops when you rest. As the disease worsens, you may find that pain occurs when you walk for shorter distances. Ultimately, as the disease progresses, you may feel pain, usually in your toes or feet, even when you are resting.
Some men who have aortoiliac occlusive disease also experience erectile dysfunction, the inability to have or maintain an erection.
Aortoiliac disease may worsen if it is not treated.
Signs that it has advanced include:
- Severe pain, coldness, and numbness in a limb;
- Sores on your toes, heels, or lower legs;
- Dry, scaly, cracked skin on your foot. Major cracks, or fissures, may become infected if left untreated;
- Weakened muscles in your legs; and
- Gangrene (tissue death), which may require amputation.
What Causes Aortoiliac Occlusive Disease ?
Atherosclerosis, or hardening of the arteries, causes most cases of aortoiliac occlusive disease.
Risk factors for hardening of the arteries include:
- High cholesterol levels in the blood;
- High blood pressure;
- Obesity; and
- Having a family history of heart disease.
To diagnose aortoiliac disease, a physician may order a variety of tests, including:
- Pulse tests;
- Blood pressure testing in the leg;
- Doppler ultrasound; and
- Arteriography, in which a contrast dye is injected into the arteries and x rays are taken.
If the disease is mild or moderate, a physician may prescribe the following:
- Maintain a healthy body weight
- Follow a physician-approved walking program
- Eat a low-fat and high-fiber diet
- Stop smoking (and all forms of tobacco use)
- Receive regular foot care from a healthcare professional (to reduce the risk of foot ulcers)
- Medication to improve blood flow in the lower extremities
If the disease is severe, treatments may include:
- Angioplasty and stenting
- Bypass surgery (to replace or bypass blocked arteries with a segment of synthetic blood vessel)
Angioplasty or Surgery
If you have severe aortoiliac occlusive disease, particularly if it does not improve with the measures described above, your physician may recommend a minimally invasive treatment called angioplasty to improve the circulation in your legs. For more extensive blockages or those that cannot be treated with angioplasty, surgery to bypass or clear your blocked arteries may be required.
During an angioplasty procedure, which is sometimes performed at the same time as an angiogram, a long, thin, flexible tube, called a catheter, is inserted into a small puncture over an artery in your leg and is guided through your arteries to the blocked area. Once there, a special balloon attached to the catheter is inflated and deflated several times. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. In some circumstances, a tiny mesh-metal tube called a stent may then be placed into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After successful angioplasty, blood flows more freely through your artery.
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