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Physiologic and Noninvasive Studies to Document Severity and Extent of Aortoiliac Occlusive Disease
The evaluation of patients who come to the hospital with symptoms of aortoiliac occlusive disease (AIOD) in the setting of peripheral artery disease (PAD) routinely includes methods for determining the anatomic location of and physiologic significance of the occlusive process. The primary decision involves assessing how disabling the symptoms are for the patient. However, for any given level of ankle measured perfusion (e.g., ankle-to-brachial index [ABI]), proximal AIOD is usually more disabling given the amount of muscle mass that is supplied distal to the occlusive processes.
Several noninvasive modalities can aid in the accurate diagnosis and physiologic assessment of the relevance of AIOD. These include ABI, segmental arterial pressures, and duplex ultrasonography.
Symptoms and Signs
Patients who come to the hospital with AIOD typically complain of hip, thigh, or buttock claudication. This location of claudication usually predominates over calf symptoms, but overlap can occur. Importantly, impotence and sexual dysfunction are present in as many as 30% to 50% of men with AIOD. Detailed history to elicit the location, severity, and duration of symptoms is essential. The physical examination is equally important, and the hallmark is diminished or absent femoral pulses. Occasionally, femoral bruits are auscultated on examination, but they are not particularly specific for critical versus noncritical disease.
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