Aortoiliac Occlusive Disease

Aortoiliac occlusive disease (AIOD) is a common form of peripheral artery disease. It affects arteries in your belly and pelvic area — specifically, the lower part of your aorta and your iliac arteries.

The typical cause is plaque buildup in these arteries, which limits blood flow to your butt and legs. This can lead to leg pain when you’re active and erectile dysfunction (in males). More severe cases can cause leg pain at rest and sores that have trouble healing.

AIOD can sometimes lead to sudden, severe blockages that need treatment right away. Call 911 or your local emergency number if you have these leg symptoms:

• Severe pain (often the first thing you’ll notice)
• Skin that’s paler than normal
• Skin that feels cool to the touch
• “Pins and needles” or numbness

Every minute counts. The longer blood flow is blocked, the more your tissues become damaged. Severe damage can lead to limb loss or death.

Symptoms of aortoiliac occlusive disease

Some people have no symptoms at all. If you do have AIOD symptoms, they can include:

• Intermittent claudication: This is pain, cramping or fatigue in your butt, thighs or calves that starts when you move around and stops when you rest.
• Erectile dysfunction: Males may have difficulty getting and keeping an erection during sex.
• Rest pain: As AIOD progresses, you may have leg pain when you’re not moving. It may wake you from sleep.
• Leg ulcers: Open sores on your legs and feet that heal slowly or don’t heal are a symptom of severe AIOD.

A common sign that your provider may find in an exam is a missing or weak pulse in your groin area. You may not notice this on your own.

What causes aortoiliac occlusive disease?

Atherosclerosis is the most common cause of AIOD. This is the gradual buildup of plaque in arteries throughout your body. The plaque narrows the space where blood can flow. With AIOD, affected arteries include your:

• Abdominal aorta (below the renal artery branches)
• Common iliac arteries
• External iliac arteries

Together, these arteries are known as the aortoiliac segment — and that’s how this condition gets its name. But many people with AIOD also have plaque in leg arteries, including the femoral arteries, popliteal arteries and their branches.

Less common causes of aortoiliac occlusive disease include Takayasu’s arteritis and radiation to your pelvis. Both can cause inflammation in your artery walls, which reduces blood flow.

Risk factors

Anyone can develop aortoiliac occlusive disease. But the risk is greater if you:

• Smoke
• Have diabetes, high cholesterol, high blood pressure or chronic kidney disease
• Have a history of peripheral artery disease in your biological family
• Were diagnosed with atherosclerosis somewhere else in your body, like your coronary arteries or carotid arteries

Your risk also goes up as you age. AIOD is estimated to exist in 15% to 25% of people over age 70. But this may be lower than the actual number, as some people don’t have symptoms.

Complications

Without treatment, aortoiliac occlusive disease can lead to serious complications, like:

• Chronic limb-threatening ischemia: Severe plaque buildup raises your risk of limb loss and death.
• Acute limb ischemia: A blood clot or piece of plaque suddenly blocks blood flow in your artery. This is a life-threatening medical emergency.
• Gangrene: Tissues in your leg or foot start to die from lack of blood flow.
• Limb loss: Severe AIOD can damage your leg so much that it can’t be saved. In this case, you need surgery to remove part or all of your leg. Early treatment can help avoid this.

How doctors diagnose this condition

Healthcare providers diagnose aortoiliac occlusive disease through a physical exam and testing. During the exam, they may feel your pulse at various points in your legs and feet. This helps them learn how well blood is reaching your lower body. They’ll also look for sores, changes in skin color and other signs of more advanced disease.

Your healthcare provider may do one or more tests to help diagnose AIOD. These include:

• Ankle-brachial index (ABI): This test compares the blood pressure in your arms versus your legs. It shows how well your blood is reaching your legs and feet.
• CT angiogram or MRA: These imaging tests show your arteries in detail. They can help if an ABI isn’t enough to reach a diagnosis. They’re also useful for planning procedures and surgeries to treat AIOD.
• Pulse volume recording: Like an ABI, this test uses blood pressure cuffs and a small ultrasound to measure the blood volume and its relative speed moving through your legs. This can help find the general location of blockages.
• Vascular ultrasound: This test shows images of your arteries and the blood flow. It can help providers see spots that are narrow or blocked.

Types of this condition

Healthcare providers classify aortoiliac occlusive disease into three types. These are based on the extent of plaque buildup in your arteries, which all connect like branches on a tree:

• Type 1: Plaque is limited to your lower aorta and its closest branches (common iliac arteries). This is typically the mildest form. Blood can usually reroute to other arteries that aren’t diseased. So, you may have mild symptoms or none at all.
• Type 2: Plaque extends into branches lower in your pelvis, just above your groin.
• Type 3: Plaque extends even farther into arteries in your thigh. This is the most severe type. It can lead to serious blood flow problems that threaten the health of your leg.

How is aortoiliac occlusive disease treated?

Treatment for AIOD depends on the severity of your condition. If you have mild or no symptoms, your provider may recommend more conservative treatments, like changes to your habits and taking some medicines. If symptoms disrupt your daily life or you’re at risk of limb loss, you may also need a procedure or surgery to improve blood flow.

Changes to your habits

Quitting smoking is one of the most important things you can do to manage AIOD (and any form of peripheral artery disease). Smoking harms all of your blood vessels, but research shows the aorta and iliac arteries are especially vulnerable. Your healthcare provider can offer resources and may prescribe medicines to help you quit.

Your provider might also recommend:

• A heart-healthy diet: This can help manage diabetes, high blood pressure and high cholesterol.
• Supervised exercise therapy: This isn’t the same as exercising on your own. A healthcare provider makes a plan for you and watches over your sessions. This can help you walk farther without leg pain.

Medications

There’s currently no medicine that specifically reverses or cures AIOD. But your provider may prescribe certain medicines to manage risk factors, slow plaque buildup and reduce symptoms. For example, you may need:

• Antihypertensive drugs to keep your blood pressure at a healthy level
• Antiplatelet drugs to lower your risk of blood clots
• Cilostazol to treat leg pain and help you walk farther
• Statins and other medications to lower your cholesterol

Procedures and surgeries

If other treatments don’t help enough, you may need a procedure or surgery. Options your provider may discuss with you include:

• Angioplasty and stenting: This procedure opens up narrowed arteries so blood can flow through better.
• Peripheral artery bypass surgery: Your surgeon makes a new route for blood to flow around narrow or blocked arteries. Often, this new path starts higher up in your aorta and connects to arteries in one or both of your thighs (aortobifemoral bypass).
• Endarterectomy: This surgery removes plaque from your arteries. Surgeons don’t use it as often for AIOD these days, but it can help in some situations.

When should I see my healthcare provider?

Your provider will tell you how often you need to come in for follow-up care. Make sure you go to all of your appointments, even if you’re feeling fine. Your provider can do simple tests to check blood flow and make sure your treatments are helping.

Also, call your provider any time you experience new or changing symptoms.

What can I expect if I have aortoiliac occlusive disease?

Your outlook depends on many things, including the extent of plaque buildup. People with type 3 AIOD (plaque that extends from their lower aorta into their legs) have a shorter life expectancy than those with type 1. But early treatment can make a big difference. Your healthcare provider will work with you to manage this condition and avoid serious complications.

What is Leriche syndrome?

Leriche syndrome was previously used to describe aortoiliac disease when you have all three of the following symptoms/signs: 

• Pain, cramping or fatigue in your thigh or butt
• Erectile dysfunction
• Absent pulse in your groin area (femoral artery)

This syndrome got its name from a French surgeon named René Leriche. His team described this “triad” of symptoms in 1948. Today, it’s more common for providers to use the term “aortoiliac occlusive disease.” That’s because not all people with this disease have this triad of symptoms/signs.