medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

, aortoiliac occlusive disease is a form of central artery disease involving the blockage of the

abdominal aorta In human anatomy, the abdominal aorta is the largest artery in the abdominal cavity. As part of the aorta, it is a direct continuation of the descending aorta (of the thorax). Structure The abdominal aorta begins at the level of the thoracic d ...

as it transitions into the

common iliac arteries The common iliac artery is a large artery of the abdomen paired on each side. It originates from the aortic bifurcation at the level of the 4th lumbar vertebra. It ends in front of the sacroiliac joint, one on either side, and each bifurcates in ...

Signs and symptoms

Classically, it is described in male patients as a triad of the following signs and

symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

s: # claudication of the buttocks and thighs # absent or decreased femoral pulses #

erectile dysfunction Erectile dysfunction (ED), also called impotence, is the type of sexual dysfunction in which the penis fails to become or stay erect during sexual activity. It is the most common sexual problem in men.Cunningham GR, Rosen RC. Overview of male ...

This combination is known as Leriche syndrome. However, any number of symptoms may present, depending on the distribution and severity of the disease, such as muscle atrophy, slow wound healing in the legs, and

critical limb ischemia Chronic limb threatening ischemia (CLTI), also known as critical limb ischemia (CLI), is an advanced stage of peripheral artery disease (PAD). It is defined as ischemic rest pain, arterial insufficiency ulcers, and gangrene. The latter two cond ...

Diagnosis

The physical examination usually shows weakened femoral pulses and a reduced ankle-brachial index. The diagnosis can be verified by color duplex scanning, which reveals either a peak systolic velocity ratio ≥2.5 at the site of stenosis and/or a monophasic waveform. MRA and multidetector

CTA CTA may refer to: Legislation *Children's Television Act, American legislation passed in 1990 that enforces a certain degree of educational television *Counter-Terrorism Act 2008 *Criminal Tribes Act, British legislation in India passed in 1871 wh ...

are often used to determine the extent and type of obstruction. Another technique is digital subtraction angiography which allows verification of the diagnosis and endovascular treatment in a single session.
Angiography provides important information regarding the perfusion and patency of distal arteries (e.g. femoral artery). The presence of collateral arteries in the pelvic and groin area is important in maintaining crucial blood flow and lower limb viability. However, angiography should only be used if symptoms warrant surgical intervention.

Treatment

Treatment involves revascularization typically using either angioplasty or a type of vascular bypass * Kissing balloon angioplasty +/- stent, so named because the two

common iliac The common iliac artery is a large artery of the abdomen paired on each side. It originates from the aortic bifurcation at the level of the 4th lumbar vertebra. It ends in front of the sacroiliac joint, one on either side, and each bifurcates in ...

stents touch each other in the

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

aorta. * Aorto-iliac bypass graft * Axillary-bi-femoral and femoral-femoral bypass (sometimes abbreviated "ax-fem fem-fem")

History

The condition was first described by Robert Graham in 1914, but the condition with its triad of symptoms was ascribed to

René Leriche Henri Marie René Leriche (12 October 1879 – 28 December 1955) was a French vascular surgeon and physiologist. He was a specialist in pain, vascular surgery and the sympathetic trunk. He sensitized many who were mutilated in the first World w ...

. Leriche, a

French French (french: français(e), link=no) may refer to: * Something of, from, or related to France ** French language, which originated in France, and its various dialects and accents ** French people, a nation and ethnic group identified with Franc ...

surgeon, linked the

pathophysiology Pathophysiology ( physiopathology) – a convergence of pathology with physiology – is the study of the disordered physiological processes that cause, result from, or are otherwise associated with a disease or injury. Pathology is the ...

with the

anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...

of the condition. John Hunter's dissections of atherosclerotic aortic bifurcations from the late 18th century are preserved at the

Hunterian Museum The Hunterian is a complex of museums located in and operated by the University of Glasgow in Glasgow, Scotland. It is the oldest museum in Scotland. It covers the Hunterian Museum, the Hunterian Art Gallery, the Mackintosh House, the Zoology M ...

, but Leriche was first to publish on the subject based on a patient he treated with the condition at the age of 30. Following treatment the 30-year-old was able to walk without pain and maintain an erection.

References

External links