Aortoiliac occlusive disease
What is it?
It is the formation of atherosclerotic plaques in the aortoiliac arterial segment, which cause lack of blood supply to lower extremities, genital organs and, in some cases, kidneys. This gradually makes it difficult to walk, leads to pain at rest and the development of ulceration and necrosis in the lower extremities. It can cause loss of sexual function in males. People with other atherosclerotic diseases (myocardial infarction, angina pectoris, stroke, etc.) and/or the following risk factors are most at risk: smoking, diabetes, high blood pressure, dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia), hyperhomocysteinaemia and some congenital diseases. Males are usually at greater risk than females and people over 50 years of age.
Which are the symptoms?
The disease is asymptomatic at first, but later a cramp-like pain in the calves, hips and buttocks develops. This pain is usually intermittent (claudication intermittens), associated with walking and physical activity, and may be accompanied by paresthesias (tingling of the skin) and loss of sexual function. As the disease progresses, pain may appear at rest and there may be signs of severe lower extremity ischaemia and/or renal failure.
- cramp-like pain in the calves, hips and buttocks
- loss of sexual function
- intermittent claudication
- peripheral ulcers
- distal gangrene
How is it diagnosed?
Patients with the symptoms described are at high risk of suspected aortoiliac steno-obstructive disease and should undergo imaging.
How is it treated?
There are different types of treatment available. Drug therapy: therapy with antiplatelet agents, which prevent platelets from binding to atherosclerotic plaques and thereby worsen the course of the disease, haemorheological drugs, which make blood more fluid and able to flow more easily within the affected vessels, and vasodilators, which increase peripheral vascularisation. Correction of the patient's individual risk factors, abstinence from smoking and appropriate physical activity are essential. Early stage of the disease may have good outcomes. Surgical treatment: replacing (bypassing) the blocked artery with a synthetic prosthesis (Dacron, PTFE) or by cleaning the artery by removing atherosclerotic plaques from the inside (endoarterectomy). Endovascular treatment can be performed percutaneously (without incisions) in cases of segmental stenosis. An arteriogram is taken and the arteries are dilated where they are stenosed (narrowed), possibly by implanting one or more stents (small metal tubes).
Where do we treat it?
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