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PATIENT STORY

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A 67-year-old man presented with a history of right hip and buttock claudication at one block distance for the past year. Over the past several days, however, he had new onset of numbness in the right foot. There was no right femoral pulse on physical examination, but he had normal motor and sensory function. He was actively smoking with a history of hypertension and coronary artery disease. An ankle-brachial index (ABI) with waveforms was performed; it showed a monophasic right ankle waveform with an ABI of 0.56 (Figure 2-1).

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FIGURE 2-1

Preprocedure ankle-brachial index with monophasic right ankle waveform.

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An angiogram was performed that illustrated a right common iliac occlusion with reconstitution of the external iliac artery (TransAtlantic Intersociety Consensus [TASC] class B lesion) (Figure 2-2) at the takeoff of the internal iliac artery (Figure 2-3). It was believed to be an acute occlusion of a chronic stenosis. The lesion was crossed using an antegrade and retrograde approach (Figure 2-4), and primary stenting was completed (Figure 2-5). The patient symptomatically improved immediately, as did his noninvasive testing results (Figure 2-6), and his claudication had resolved by his follow-up visit.

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FIGURE 2-2

TASC II classification for aortoiliac occlusive disease from TASC II Working Group.1 CFA, common femoral artery; CIA, common iliac artery; EIA, external iliac artery.

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FIGURE 2-3

Angiogram indicating right iliac artery occlusion. Image on the left shows location of occlusion (blue arrow). Image on the right shows the common iliac artery where the occlusion ends (blue arrow) and reconstitution of the distal common iliac artery.

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FIGURE 2-4

Lesion crossing using antegrade and retrograde approach (blue arrows).

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FIGURE 2-5

Stenting of iliac occlusion. The image on the left shows both dilated balloons ("kissing balloons") in place. The right image shows both iliac stents in place.

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FIGURE 2-6

Postprocedure improvement in ABI back to normal.

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EPIDEMIOLOGY

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  • Aortoiliac occlusive disease (AIOD) is just one manifestation of peripheral arterial disease (PAD) that affects 8 to 12 million Americans. Almost half of patients with PAD are asymptomatic.

  • If claudication exists, the prognosis is generally good since 70% to 80% of patients' claudication remains stable over a 10-year time period.2

  • Unfortunately, the risk of stroke, myocardial infarction, and cardiovascular death is increased in patients with PAD.

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