Aortoiliac Occlusive Disease

What is aortoiliac occlusive disease?

Aortoiliac occlusive disease is a form of peripheral artery disease (PAD). It affects the lower part of your aorta and your iliac arteries. Plaque (a sticky substance made of fats and cholesterol) gradually builds up in these arteries. This plaque is dangerous because it can:

• Reduce blood flow in your arteries: As your arteries narrow, your blood has less room to flow.
• Trigger an embolus: A piece of plaque can break off (embolus). An embolus travels through your bloodstream and gets stuck in an artery. There, it blocks blood flow.

How does aortoiliac occlusive disease affect my body?

Aortoiliac occlusive disease interferes with blood flow in your aorta and iliac arteries. It leads to complications when oxygen-rich blood can’t reach your body’s tissues. To understand how this disease affects your blood flow, it’s helpful to know the basic anatomy of these arteries.

Your aorta is the largest blood vessel in your body. It extends upward from your heart and then curves downward through your chest and belly (abdomen). Along the way, many arteries branch off from your aorta and carry blood to different parts of your body. Picture a main road with many side streets that intersect with it. Your aorta is the main road. The artery branches are the side streets.

For example, your renal arteries branch off to the left and right from your aorta to supply blood to your kidneys. This intersection is important. It’s the upper boundary where aortoiliac occlusive disease begins. Your aorta continues beyond this intersection and leads down to your belly button (navel). Healthcare providers call this stretch of your aorta the “infrarenal aorta,” since it’s below your renal arteries.

When your aorta reaches your navel area, it splits to form your two iliac arteries. Picture an upside-down letter “Y.”

Your right common iliac artery travels down into your right leg, and your left common iliac artery travels down into your left leg. More arteries branch off from each common iliac artery. Your iliac arteries and their branches supply blood to many parts of your lower body, including your:

• Butt.
• Feet.
• Hips.
• Legs.
• Male reproductive system or female reproductive system.
• Pelvic organs (such as your bladder and liver).

How aortoiliac occlusive disease affects your body depends on which parts of the upside-down “Y” are narrowed or blocked. Mild forms of the disease only affect a small part of your arteries and may cause mild or no symptoms. That’s because your blood can still pass through or else reroute to other arteries that aren’t diseased. But more severe forms interfere with blood flow to many branches. So you’ll feel more symptoms and face a higher risk of complications.

Who does aortoiliac occlusive disease affect?

Aortoiliac occlusive disease affects more than 6 million adults ages 40 and older in the U.S. Your risk goes up as you age. This disease affects fewer than 5% of people in their 50s but more than 20% of people in their 80s. It’s more common in people who are male or designated male at birth (DMAB) and in people who are Black.

Is aortoiliac occlusive disease life-threatening?

Without treatment, aortoiliac occlusive disease can lead to serious and sometimes life-threatening complications. These include:

• Amputation.
• Heart attack.
• Heart failure.
• Gangrene.

What are the symptoms of aortoiliac occlusive disease?

Some people have no symptoms at all. If you do have symptoms of aortoiliac occlusive disease, they can include:

• Erectile dysfunction (ED): Inability to get and keep an erection during sex.
• Intermittent claudication: Pain or cramping in your butt or legs that starts when you exercise and stops when you rest.
• Rest Pain: Leg pain that wakes you up. It occurs especially at night when your legs are elevated and gravity isn't helping pull blood down your legs.
• Ulcers: You may notice open sores (ulcers) on the skin of your legs or feet.

If you notice these symptoms, call your healthcare provider to discuss how you’re feeling. It’s important to catch signs of aortoiliac occlusive disease early so your provider can recommend treatment. Plus, your provider may check for blood flow problems in other parts of your body, like your carotid arteries or coronary arteries. Usually, plaque buildup in one part of your body signals you have plaque buildup elsewhere too.

In severe cases, you may develop symptoms of acute arterial occlusion. This is a medical emergency. It means part of your body (usually your leg or foot) isn’t getting enough oxygen-rich blood. Symptoms include the “six Ps”:

1. Pain: Severe pain is a common symptom and usually the first one you notice.
2. Pallor: Your skin looks very pale.
3. Pulse deficit: Your pulse is weak or missing.
4. Poikilothermia (sometimes called “polar sensation”): Your skin feels cool when you touch it.
5. Paresthesia: You have a “pins and needles” feeling.
6. Paralysis: You can’t feel or move your affected limb.

If you develop any of these symptoms, call 911 or go to your nearest emergency room right away. Every minute counts. The longer your blood flow is blocked, the more your tissues become damaged. Severe damage can lead to amputation or even death.

What causes aortoiliac occlusive disease?

Atherosclerosis is the most common cause of aortoiliac occlusive disease. Atherosclerosis is the gradual buildup of plaque in arteries throughout your body. In this case, the plaque builds up in your lower aorta and your iliac arteries.

Less common causes include:

• Radiation to your pelvic area.
• Vasculitis (inflammation of your blood vessels).

Risk factors for aortoiliac occlusive disease

Anyone can develop this disease since anyone can develop atherosclerosis. But your risk goes up as you get older. Family history also plays a role. Tell your healthcare provider if you have close biological family members with peripheral artery disease (PAD).

Smoking raises your risk of aortoiliac occlusive disease and other problems with your blood vessels. If you smoke or use any type of tobacco product, talk with your provider about how to quit.

Some medical conditions raise your risk of developing aortoiliac occlusive disease. These include:

• Diabetes.
• High blood pressure.
• High cholesterol.
• Takayasu’s arteritis.

How is aortoiliac occlusive disease diagnosed?

If you have symptoms of aortoiliac occlusive disease, make an appointment with your healthcare provider. To diagnose this condition or determine if there’s another cause, your provider will:

• Ask you questions.
• Perform a physical exam.
• Perform tests.

Your provider will begin by asking you questions to learn more about your condition. These questions may include:

• What are your symptoms?
• When do you notice these symptoms?
• What makes the symptoms go away?
• How long have you had these symptoms?
• Have your symptoms gotten worse?

Your provider will also ask about your:

• Family history: It’s important to share what you know about your biological family members’ health. Certain conditions like peripheral artery disease can run in families.
• Medical history: Your provider needs to know about your past and current medical conditions. Some conditions raise your risk of blood vessel disease.

Your provider will also perform a physical exam to learn more about your overall health.

What tests will be done to diagnose aortoiliac occlusive disease?

Your healthcare provider may perform one or more tests to help diagnose your condition. These include:

• Ankle-brachial index (ABI): This non-invasive test compares the blood pressure in your arms versus your legs. It shows how well your blood is flowing down to your legs and feet.
• Blood tests: These can show risk factors for heart and blood vessel problems, plus help your provider learn about your overall health.
• Computed tomography angiogram (CTA): This is like a coronary CTA but focuses on your affected limb.
• Vascular ultrasound: Like other forms of ultrasound, this test uses high-frequency sound waves. It checks what’s going on inside your body. In this case, your provider checks how well your blood is flowing through the arteries in your legs.

What is the treatment for aortoiliac occlusive disease?

Treatment depends on the severity of your condition. In some cases, lifestyle changes and medications help manage your condition and slow down its progression. Your healthcare provider may recommend:

• Antihypertensive medication to regulate your blood pressure.
• Antiplatelet medication, like aspirin or clopidogrel, to lower your risk of blood clots.
• Dietary changes,like following the Mediterranean diet or DASH diet, to manage diabetes and other risk factors.
• Exercise to lower many risk factors and help your blood flow better in your legs.
• Medication (like Cilostazol) to treat intermittent claudication.
• Statins to lower your cholesterol.
• Quitting smoking or using any tobacco products.

If lifestyle changes and medications don’t help enough, you may need:

• Bypass surgery: Creates a new path for your blood to flow around the narrowed or blocked part. This is like a coronary artery bypass. There are different options for where the bypass begins and ends, depending on the location of your blockages and your overall health.
• Stent placement: Widens the affected part of your arteries and improves blood flow. Your provider can use endovascular methods (minimally-invasive) to insert your stent.

Your healthcare provider will tell you more about the benefits and risks of each type of procedure. Talk with them to learn which treatment methods are best for you.

How can I prevent aortoiliac occlusive disease?

You may not be able to prevent aortoiliac occlusive disease. But some things you can do to lower your risk include:

• Avoid smoking and all tobacco products.
• Eat a heart-healthy diet low in saturated fat, cholesterol, salt and sugar.
• Exercise regularly, based on your provider’s guidance.
• Manage your blood pressure, blood sugar and cholesterol.
• Take your medications as prescribed.
• Visit your healthcare provider for yearly check-ups.

If you have risk factors for aortoiliac occlusive disease or atherosclerosis, talk with your provider. The sooner you start managing your risk factors, the better your chances of preventing serious complications later on.

What can I expect if I have aortoiliac occlusive disease?

Talk with your healthcare provider about your specific prognosis. In general, procedures like bypass surgery and stent placement are successful and durable. Your provider will tell you more about what to expect from your treatment plan.

How do I take care of myself if I have aortoiliac occlusive disease?

Closely follow your healthcare provider’s guidance for lifestyle changes and medications. It’s also important to be an active partner with your provider in your medical care. This means:

• Talk with your provider about the details of your condition so you understand what’s happening inside your body.
• Ask questions when you don’t understand something.
• Ask what you can do on your own to slow down disease progression.
• Learn what symptoms mean and what to do when you experience symptoms.
• Learn about treatment options.
• Ask your provider about resources and support groups that can help you manage your condition and meet others who’re in the same boat.

When should I see my healthcare provider?

Visit your healthcare provider for yearly check-ups, and keep all your follow-up appointments. Your provider will tell you how often you need to come in and when you need tests or procedures.

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

A note from Cleveland Clinic

Aortoiliac occlusive disease is a form of peripheral artery disease that may affect your quality of life. It could also lead to serious complications. The good news is that you can take action each day to lower your risk and slow the progression of the disease. Talk with your healthcare provider about how to manage your condition and what to expect going forward.