Aortoiliac Occlusive Disease - Frequently Asked Questions Video Transcript
Video by Sean Lyden, MD
Staff Surgeon in Cleveland Clinic's Department of Vascular Surgery
Specialties: Minimally invasive (endovascular) repair of thoracic and abdominal aortic aneurysmal disease, endovascular treatment of carotid artery and lower extremity artery disease.
Hello. I’m Dr. Sean Lyden, a vascular surgeon in the Mller Family Heart & Vascular Institute. Today I’m going to talk about aortoiliac occlusive disease – what it is and how it is treated.
Aortoiliac occlusive disease is a term that refers to blockages in the blood vessels (or arteries) located in the abdomen, below the kidneys, that run down to the groins. Aortoiliac occlusive disease is a type of peripheral arterial disease, or PAD, a disorder that occurs in the vessels that carry blood to the legs. It occurs when these arteries slowly become narrowed or blocked with plaque, a condition known as atherosclerosis. This process is similar to plaque buildup in other blood vessels, including the heart and brain arteries.
Aortoiliac occlusive disease is most common among those over the age of 50, who have high cholesterol, high blood pressure, who smoke, or have diabetes.
Most people with peripheral arterial disease and aortoiliac occlusive disease are not aware that they have the condition. When the disease begins, many patients do not have any signs or symptoms of the blockages. As the disease progresses, it causes heaviness or achiness in the legs, hips and calves when walking. Many people commonly attribute their symptoms to growing older or arthritis. Signs that the disease is advanced include pain in the legs at night and pain that occurs without exercise. Patients with advanced disease may also develop ulcers on their legs or gangrene due to the decreased blood flow.
There are several tests that your physician may conduct to confirm whether you have aortoiliac occlusive disease, and if so, the extent of your condition. These may include an overall history and exam, an ankle-brachial index (or ABI) that measures blood pressure in your ankle and arm, Doppler ultrasound that can determine specifically which arteries are blocked, and angiography that can provide better resolution to identify the location and pattern of blockages.
Treatment includes exercise therapy, lifestyle modification and medication to control high cholesterol and blood pressure. The majority of treatments for aortoiliac occlusive disease are minimally invasive catheter-based – or interventional – therapies, such as angioplasty and stents. Open surgical repair is performed less commonly and is sometimes coupled with catheter-based interventions to decrease the invasiveness of the procedure. Only 10 years ago, open surgery would have been the only available option.
At Cleveland Clinic, our vascular surgeons are very pro-active, and experienced, in the minimally invasive approaches used to treat aortoiliac occlusive disease. These interventional therapies can be used alone or in combination with an open approach, such as an endarterectomy that scoops out the blockage from the blood vessel or a bypass that uses a healthy segment of blood vessel to reroute the blood flow around the blockage.
When minimally invasive means alone are used, it can mean the difference between a seven- to 10-day hospital stay with a two- to three-month recovery and an overnight hospital stay with minimal discomfort. However, your surgeon will work with you to determine what approach is best to treat your aortoiliac occlusive disease.
Cleveland Clinic experts also work with patients to control their risk factors to help them recover and avoid the recurrence of aortoiliac occlusive disease. Thank you.
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