Aorto-iliac occlusive disease

Aorto-iliac occlusive disease refers to complete occlusion of the aorta distal to the renal arteries.

When the clinical triad of impotence, pelvis and thigh claudication, and absence of the femoral pulses are present, it may also be called Leriche syndrome, which usually affects younger (30-40 years old) males 9.

Aortoiliac occlusive disease is more common in elderly with an advanced atherosclerotic disease. Acute onset is more common in female patients and is associated with poor outcome with approximately 50% mortality.

In acute cases, symptoms include the 6 P's:

  • pain
  • pulselessness
  • pallor
  • paresthesia
  • paralysis
  • prostration 

In chronic onset cases, mostly in arteriosclerosis, symptoms may include erectile dysfunction or impotence.

The condition can be acute or chronic.

Location

Most often the occlusion occurs near the aortic bifurcation. It typically begins at the distal aorta or common iliac artery origins and slowly progresses proximally and distally over time.

Aetiology

A large network of collateral parietal and visceral vessels may form to bypass any segment of the aortoiliac arterial system. In abdominal aortoiliac stenosis and occlusion, the most commonly occurring collateral pathways to the lower extremities are 5

CT angiography is usually the best modality for assessment. In patients where CT is not possible, contrast-enhanced MR angiography may be a good option 4.

CT angiography

Allows direct anatomical visualisation of the location of the stenosis and occlusion, the presence of a concomitant occlusive disease affecting visceral arteries, the type and extent of collateralization, and the level of the most proximal and distal arterial segments amenable to stent-graft placement.

Traditional surgical treatments for aortoiliac occlusive disease are 8

  • aortoiliac endarterectomy (TEA)
  • aortobifemoral bypass (AFB) 
  • axillofemoral bypass (extra-anatomic technique); used to avoid abdominal surgery 
  • percutaneous transluminal angioplasty (PTA) and stenting

It is named after French surgeon René Leriche who initially described the findings in 1948 3.

Imaging differential considerations include

  • mid aortic syndrome: occurs at or above renal artery level with a longer segment involvement and usually in much younger patients (usually 10-30 years old)

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Article Information

rID: 1580
System: Vascular
Section: Pathology
Synonyms or Alternate Spellings:
  • Leriche's syndrome
  • Aortoiliac occlusive disease
  • Aorto-iliac occlusive disease

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