Aorto-iliac occlusive disease - Mcglade Vascular Surgery

What is aorto-iliac occlusive disease

Aortoiliac occlusive disease is when there is an issue within the aorta due to a narrowing or blockage from a build-up of fatty plaque. This commonly occurs below the level of the kidney arteries and can extend into the iliac arteries, which are the main blood vessels supplying the legs. The result of this can be pain when walking in either the legs or the buttock region or in more serious cases non-healing wounds and gangrene.

The aorta is the main blood vessel in the body. It starts in the chest and travels upwards and arches over backwards then travels down in front of the spine. At the bellybutton level it splits into two and one large artery supplies each leg.

Lifestyle and Medical factors such as:

ALIF surgery is divided into three stages.

The above factors are usually the causative factors behind the build-up of fatty plaque, which causes narrowing or occlusion in the iliac vessels or aorta.

A decrease in the blood flow to the leg will usually present as pain when walking especially in the calves or thighs, occasionally the pain will be in the buttock region. In more advanced cases there may be wounds on the legs or feet that do not heal, pain at rest, ulcer formation and gangrene.

Management and treatment

The initial management of aorta-iliac disease is to determine the level and severity of the blockages in the arteries. Following this both medical and surgical management can be implemented to assist a patient.

Medical management

Occlusive disease in the aorta or the iliac vessels is indicative of a systemic issue with buildup of fatty plaque in the body’s arteries. Good medical therapy includes aspirin, cholesterol reducing medication, lifestyle modification and Blood Pressure control. These changes are essential to treat not only the disease in the aorta but also the disease in the other arterial beds in the body. The aim of this management is to prevent other sequela of arterial disease such as heart attack or stroke.

Surgical management

Surgical or interventional (keyhole surgery) can be used to either bypass around the blockages or to place stents to reopen the occluded arteries.

Endovascular or keyhole surgery can be used to reopen occluded or narrow blood vessels. This is done by passing a wire from the groin through the narrow or blocked segment of the artery. Once the wire is in the optimal location a balloon is introduced over the wire and a stent is deployed within the artery to re-establish the normal channel of flow.

Bypass surgery is typically performed on younger and fitter patients or on patients who are not suitable for endovascular treatment. Bypass surgery typically involves the use of a prosthetic graft which is sewn onto the aorta and tunnelled to one or both groins where it is also sewn onto the arteries as they enter the legs. The decision whether to have endovascular or bypass surgery should be individualised to the patient.

Consultation with Dr McGlade

During your initial consultation Dr McGlade will take a thorough history and examination and most likely order further investigations such as an ultrasound or CT scanning of your arteries. This will enable him to define the extent of your arterial disease.

With the results of the above investigations Dr McGlade will then tailor a treatment plan to your needs. This may require further investigation as to your fitness level for major open surgery or discussing with you the option of keyhole surgery. Dr McGlade may also recommend a conservative course of action with exercise and walking therapy in attempt to avoid the need for any surgery.

Your treatment plan including procedures will be discussed in detail including all its risks and benefits and the reasons for his recommendation. You will have time to ask any questions you have prior to proceeding with a treatment plan that you are comfortable with. A family member or friend are more than welcome to join you during your appointment.