Advances in Diagnosis, Treatment, and Prognostication in Aortoiliac Occlusive Disease

Abstract

Background: Aortoiliac disease (AID) is a variant of peripheral artery disease affecting the infrarenal aorta and iliac arteries. Similar to other arterial diseases, aortoiliac disease obstructs blood flow to distal organs through narrowed lumens or by embolization of plaques. AID, when symptomatic, classically presents with a triad of claudication, impotence, and absence of femoral pulses, a triad also referred as Leriche Syndrome (LS). Objective: The authors aim to review the available evidence on the management of the aortoiliac occlusive disease and describe its clinical characteristics, diagnosis and treatment management. Methods: A comprehensive review of the literature was carried out to collate data from relevant studies concerning patients with moderate to severe symptomatic aortic occlusive disease. The data was identified by a search using PubMed and Google Scholar with the keywords / MESH terms "aortoiliac occlusive disease". For this study, the authors focused on publications in the past two decades, using English publications. Results: The diagnosis and evaluation of extensive aortoiliac disease involves several important considerations: vascular imaging plays a fundamental role in confirming the diagnosis of peripheral arterial disease (PAD), evaluating the severity and extent of the disease and not directing the planning of revascularization procedures. It provides essential information to select the most appropriate treatment modality. Conclusion: Even with revascularization, patients are at high risk of mortality and numerous life-threatening complications. Clinical and imagiologic factors may be used for risk stratification in order to select appropriate patients for revascularization and to better counsel patients about expected postoperative outcomes.