Diagnosing Aortoiliac Occlusive Disease

Vascular specialists at NYU Langone are experienced in recognizing the signs of aortoiliac occlusive disease and working quickly to manage it.

Aortoiliac occlusive disease is a type of peripheral artery disease that affects the iliac arteries in the pelvis and the femoral arteries in the legs, which supply blood to the lower half of the body. The iliac arteries carry oxygenated blood from the heart via the aorta, divide at the abdomen into each leg, and branch into the femoral arteries and numerous smaller arteries that extend into the toes.

The condition is caused by atherosclerosis, a buildup in the arteries of a waxy substance called plaque, which contains cholesterol, fat, and calcium. Plaque can narrow or stiffen the iliac arteries, reducing the flow of oxygen-rich blood to the pelvis and legs.

Symptoms, which may include pain, cramping, or fatigue, tend to occur during exercise but dissipate when you’re sedentary. This pain is called intermittent claudication; it typically affects the buttocks, thighs, and legs. 

Because aortoiliac occlusive disease affects blood flow to the pelvis, men with this condition may also experience erectile dysfunction.

As the disease progresses, more severe symptoms may appear, including extreme pain, coldness, and numbness in the legs—even when you’re at rest. These result from ischemia, a decrease in the supply of blood and oxygen to tissues. 

Ischemia may also cause tissues in the foot to break down, producing open sores, or ulcers. It may also lead to tissue death, or gangrene, which can result in limb loss without proper treatment. A person may also experience muscle atrophy, or shrinkage, in one or both legs. 

Risk Factors

A leading risk factor for aortoiliac occlusive disease is hypertension, or high blood pressure, which can damage artery walls, making you prone to narrowing or blockages. High blood pressure can also increase the risk of atherosclerosis, the main cause of aortoiliac occlusive disease. 

Other risk factors include smoking, obesity, diabetes, and hyperlipidemia, a condition caused by unhealthy levels of fats in the blood. People who are sedentary are at increased risk for the conditions that lead to aortoiliac occlusive disease.

Diagnostic Tests

To diagnose aortoiliac occlusive disease, your NYU Langone doctor examines your legs and takes a medical history to determine if you have risk factors. The doctor takes your blood pressure and pulse in the thigh, calf, and foot to help determine if there is a blockage in the aorta or in the iliac or femoral arteries, which causes inadequate blood flow.

Your doctor may order one or more other tests to look for signs of an arterial blockage in the pelvis or leg.

Arterial Doppler Ultrasound

A Doppler ultrasound uses sound waves to produce color images that show the flow of blood through the arteries of the pelvis and legs. It allows the doctor to detect and evaluate blockages caused by plaque buildup. 

During the ultrasound, a handheld instrument called a transducer is pressed against your skin to transmit sound waves. It produces images of the blood vessels in the pelvis and legs on a computer monitor. The test takes about 30 to 60 minutes. 

Ankle–Brachial Index 

An ankle–brachial index allows doctors to determine the severity of blockages in the arteries in the lower part of the body. 

In this test, your doctor measures blood pressure in the ankle and in the arm and compares the results. A low ankle–brachial index can indicate a blockage. This test can also help determine the risk of heart attack and stroke.

CT Scans

In a CT scan, X-rays and a computer create three-dimensional, cross-sectional images of the body. The test helps the doctor determine if you have any narrowing or blockages in the pelvic or leg arteries. 

Before the scan, you may be given an intravenous (IV) dose of a contrast agent, a liquid dye that travels through the blood vessels to enhance the images. The test typically takes 10 to 15 minutes to complete.

Angiogram

An angiogram uses X-rays to detect blockages in the arteries. During this test, your doctor uses a needle to make a small puncture near the groin and inserts a catheter, which is guided into an iliac artery. He or she injects a contrast dye into the catheter to highlight any narrowed or blocked arteries. 

Sometimes, this test is done at the same time as a procedure called balloon angioplasty and stenting to clear and widen blocked or narrowed arteries. Performed using local anesthesia, angioplasty and stenting can take less than an hour or up to several hours, depending on the severity of the condition. 

During the angiogram, you may feel pressure when the catheter is inserted and a warm sensation when the contrast material is injected. Afterward, your doctor may suggest avoiding certain activities, such as lifting heavy objects and exercising strenuously, to prevent bleeding in the area where the catheter was inserted.