Alexander H. Hou MD, FACS,
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.
When your iliac arteries narrow or become blocked, your legs may not receive the blood and oxygen they need. This lack of oxygen is called ischemia and it can cause pain. In severe cases, sores or gangrene can develop, which can result in losing a limb. However, these developments are uncommon unless the process is not treated and is allowed to progress.
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
• Gangrene (tissue death), which may require amputation
If you experience any of these advanced symptoms, it usually means that your leg arteries are blocked in more than one place. Your physician may need to treat more than one site to prevent gangrene or limb loss.
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
– Having a family history of heart disease
In rare cases, a condition known as Takayasu’s arteritis may cause blockages in your aorta and its branches. Takayasu’s arteritis usually affects young Asian women between the ages of 10 and 30. It is caused by inflammation in the arteries.
How is aortoiliac occlusive disease treated?
In mild to moderate cases, your physician may recommend that you change certain aspects of your lifestyle. If you are a smoker, the most important step you can take is to quit smoking. Chemicals in tobacco can damage your arteries. These chemicals can also increase your chance of having complications from aortoiliac occlusive disease.
In addition to quitting smoking, your physician may recommend that you maintain a healthy weight, follow a structured walking program at least 3 or 4 times a week, and eat a low-fat and high-fiber diet. These changes help slow hardening of the arteries. If necessary, your physician may prescribe medications to lower high cholesterol.
If you have high blood pressure, regular monitoring of your blood pressure and compliance in taking medication if prescribed is important. If you have diabetes, you need to control your blood sugar levels with diet and medication.
In addition, if you have diabetes, you may develop impaired sensation in your feet, a condition called neuropathy. Your physician may recommend that you receive foot care from a qualified healthcare professional and learn the basics of caring for your feet at home. This includes practicing foot hygiene, wearing protective, well fitting, and cushioned footwear, and avoiding injuries to your foot. This type of care can be very important because, as you lose the protective feeling in your feet, you can develop sores on them that may be difficult to heal.
If you do not have a disqualifying medical condition, such as heart failure, your physician may also prescribe cilostazol (Pletal), which may improve the distance you are able to walk without pain. Other drugs your physician may prescribe include aspirin or clopidogrel (Plavix), either of which can lower your chances of blood clots. Statins are a class of medications that your physician may use to control your cholesterol levels. None of these medications will “cure” you of the disease, but are important at relieving some of your symptoms, and may help protect your arteries from developing further disease.
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.
The best choice of the treatment depends upon the pattern of blockage as well as how much blockage you have. Your vascular surgeon will help you determine which method of treatment is best for your particular situation.
Alexander H. Hou MD, FACS, is a skilled Board Certified and fellowship trained vascular surgeon specializing in the treatment of arterial and venous diseases employing both open and endovascular techniques. Dr. Hou is a member of Society for Vascular Surgery, a premier society for vascular surgeons, in addition to several other regional vascular societies, also a Fellow of American College of Surgeons. He has publications in several peer reviewed journals focusing on vascular diagnostic and interventions using duplex ultrasound.
Dr. Hou has been practicing in Ashland since 2005 and is known for delivering high quality vascular care exemplified by the “minimal incision” surgical technique resulting in less pain, better healing and esthetically more appeasing scars.
Vascular Institute of Kentucky
Medical Plaza A
617 23rd Street, Suite 105
Ashland, KY 41101