Aortoiliac Occlusive Disease

Aortoiliac occlusive disease is a condition where there is narrowing of the aorta, or one of its major branches. The narrowing reduces the flow of blood to your lower body, particularly your legs and pelvic organs.



The aorta and iliac arteries are the second most likely blood vessels to be affected. The aorta is the largest artery in the body. It begins at the left ventricle of the heart and continues, branching into arteries throughout the rest of the body. The iliac arteries are located on each side of the body, pooled together in the middle of each leg, just above the knee. They carry oxygen-rich blood from the aorta to the legs, hips, and genitalia.


Symptoms of aortoiliac occlusive disease vary widely. In its earliest stages, you may experience fatigue, pain, or cramping when walking. Erectile dysfunction is common in males with the condition. As the disease progresses, symptoms may occur after walking very short distances. Men may also experience pain at rest and problems with their legs and feet—including coldness, numbness, sores or wounds on their legs and feet, as well as gangrene or the death of tissue in their feet.


Aortoiliac disease is usually caused by atherosclerosis, which can be accelerated by smoking, high cholesterol, high blood pressure, a genetic predisposition or obesity. Inflammatory conditions such as Takayasu’s arteritis may also cause inflammation in the arteries leading to blockages of the arteries. Radiation treatment to the pelvis can cause progressive inflammation in the arterial wall as well.


Initial tests may include an ankle-brachial index test and duplex ultrasound. If further testing is needed, a CT angiogram, MR angiogram, or catheter-directed angiogram may be recommended. These studies use different types of dye to help identify where blockages in the arteries are located to plan further treatment.


Risk Factor Modifications

Risk factor modification may include smoking cessation, control of cholesterol, high blood pressure and diabetes control, exercise and medication to prevent blood from clotting. Medication such as aspirin or a statin drug may be prescribed to help control cholesterol and also help prevent plaque progression.

Minimally Invasive Stent Placement 

The most common minimally invasive treatment for atherosclerosis is the placement of a stent in your aorta or iliac arteries. A catheter-directed angiogram test can also be done at the same time as the stent placement. The stent compacts the plaque against the walls of the arteries to create a wider path for blood flow to the lower half of your body. An angioplasty, in which an inflatable balloon device is inserted through the catheter to further assist in opening up the arteries, can be added to this treatment if needed.

Surgical Bypass

A surgical bypass, or angioplasty, is a procedure to increase the flow of blood around an area of blockage in your body. In the case of leg blockages, bypasses are typically performed on both sides at once. For severe disease requiring surgery, bypasses are often done from the aorta to the groin. If there is not a suitable artery in the groin area, or if you do not feel that you are healthy enough for aortic surgery, your bypass will usually start at your axillary artery (underneath your collarbone) and end in one or both legs.



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Please contact our ARA Cares Coordinator at (828) 436-5500 with any additional questions or concerns.