Aortoiliac Occlusive Disease - Classification, Symptoms, Diagnosis, and Treatment

Introduction:

The aortoiliac occlusive disease is a kind of central artery disease that involves the obstruction of the abdominal aorta as it passes its way down into the common iliac arteries. The aortoiliac occlusive disease is also known as just aortoiliac disease or Leriche Syndrome- a type of peripheral arterial disease or PAD. The aortoiliac occlusive disease is primarily caused by the obstruction of an artery due to atherosclerosis and the resulting plaque formation, as well as thrombosis and embolism. The aortoiliac occlusive disease generally affects several parts of the abdominal aorta, especially the distal aorta and beyond. The aorta then begins to give off the branches of the renal branches into the L1 or L2 level of the spine as well as branches into the right and the left common iliac arteries at the L4 level of the spine. The severity of the disease depends on the underlying reason and etiological factors and can be present as an acute or chronic condition. A few of the imperative reasons include thrombosis along with embolism. On the other hand, a few of the chronic reasons can consist of the atherosclerotic formation of plaque.

How Is Aortoiliac Occlusive Disease Classified?

Aortoiliac disease is classified into four categories or groups for a more straightforward diagnosis and understanding of the condition according to trans-Atlantic intercontinental consensus guidelines and is mentioned below.

• Trans-Atlantic Intercontinental Consensus Type A Iliac Lesions: Single stenosis that is less than three centimeters.

• Trans-Atlantic Intercontinental Consensus Type B Iliac Lesions: Single stenosis that is anywhere between three to ten centimeters in length. It may also be a total of two stenoses that is less than five centimeters in length.

• Trans-Atlantic Intercontinental Consensus Type C Iliac Lesions: A bilateral stenosis that is five to ten centimeters long; it can be unilateral or bilateral.

• Trans-Atlantic Intercontinental Consensus Type D Iliac Lesions: These lesions are diffuse and are multiple as well as unilateral, generally more than ten centimeters in length. This can involve a diffuse disease that involves the aorta and both the iliac arteries. This classification is also for those patients who have iliac stenosis along with abdominal aortic aneurysms or any other kind of lesion that requires an aortic or iliac surgery.

What Are the Changes That Take Place in the Body During an Aortoiliac Occlusive Disease?

The pathogenesis and the pathophysiology of aortoiliac occlusive disease are usually characterized by atherosclerotic development and the formation of plaque and related buildup. Thrombosis and embolus formation is then followed. Atherosclerosis refers to the harmful buildup of cholesterol plaques within the walls of the arteries. Damage to the inner layer, also called the endothelial layer of the blood vessel walls, eventually allows the inflammatory cells, inflammatory mediators, and fatty acids to quickly enter these layers of the blood vessel, such as the artery. Over time, the plaque deposits may enlarge in size and have the potential to cause stenosis of the blood vessel. Because of this, thrombosis begins to occur when a part of the plaque dislodges to another location and becomes the causative agent for occlusion. On a general pathology- cholesterol plaques, fatty deposits, and parts of ulcerations with hemorrhages are the characteristic findings of blood vessel atherosclerosis and the formation of thrombus in aortoiliac occlusive disease.

What Are the Signs and Symptoms of Aortoiliac Occlusive Disease?

The clinical manifestations of aortoiliac occlusive disease vary from patient to patient. Mentioned below are a few of the signs and symptoms of aortoiliac occlusive disease.

• Claudication of the lower limbs as well as the buttocks.

• Presence of pallor in the lower limbs.

• Presence of numbness in the lower limbs.

• Weakness of the lower limbs.

• Soreness of the extremities.

• Loss of femoral pulse rate.

• Erectile dysfunction.

• Atrophy of the lower limb muscles.

• Presence of Leriche syndrome.

• Slow wound healing.

• Limb ischemia of critical nature.

What Are the Causes of Aortoiliac Occlusive Disease?

The causes of aortoiliac occlusive disease are generally parallel to a lifestyle that is not very active. Mentioned below are the causes of this disease, and all of them can be possibly avoided by considering heart-healthy measures.

• High cholesterol levels.

• High blood pressure readings.

• A habit of smoking.

• Diabetes mellitus (uncontrolled blood glucose levels in the body).

• Being overweight or obese.

• Not getting enough amount of exercise on a regular basis.

• Constantly eating an unhealthy diet.

• A family history of heart or any other cardiovascular disorder.

• Inactivity and following an inactive lifestyle.

• Tobacco and related products have nicotine in them, which irritates the inner tissues of arteries.

• Family history of carotid artery disease or any other cardiovascular disorder.

• Genetic predisposition.

How to Diagnose Aortoiliac Occlusive Disease?

In the majority of cases of aortoiliac occlusive disease, the diagnosis is only made after the patient has explained all the medical history along with the family history. Mentioned below are a few of the diagnostic tools to determine the aortoiliac occlusive disease.

• Duplex ultrasound.

• Computed tomography angiography.

• Cerebral angiography.

• Magnetic resonance angiography.

• Chest X-ray.

• Infrared thermography.

• Digital subtraction angiography.

• Magnetic resonance imaging or MRI.

How to Treat Aortoiliac Occlusive Disease?

The treatment of aortoiliac occlusion disease involves revascularization management that is typically done by using either an angioplasty technique or a type of vascular bypass method. Mentioned below are a few of the treatment options for aortoiliac occlusion disease.

• Kissing balloon angioplasty with or without a stent.

• Aorto-iliac bypass graft.

• Axillary-bi-femoral bypass surgery.

• Femoral-femoral bypass surgery.

Conclusion:

The aortoiliac occlusive disease is a disease of the blood vessels that results in the blockage of the aorta. Aorta is the most extensive and most robust blood vessel in the entire body. Any hampering in its function will lead to a domino effect in the smooth blood flow within the circulatory system. This condition is diagnosed through several available diagnostic measures, and the clinical manifestation varies from patient to patient. Treatment is possible via the available options and is decided by the healthcare provider. Living a heart-healthy life is the key to avoiding aortoiliac occlusive disease.