- The aorta is the biggest blood vessel in your body, running from the chest into the abdomen before it splits into both sides of the pelvis and both legs, like an upside down Y. When this blood vessel dilates and begins to expand like a balloon, it is called an aneurysm. This can continue to grow with the pressure of the blood stream pushing against the wall. If it becomes too large, the risk to the patient is rupture of the artery. This is LETHAL in most cases. It is for this reason that most aneurysms are fixed electively when they become larger than 5 or 5.5 cm (about 2 inches across).
- The traditional treatment for AAA involved a large, open incision in the abdomen with clamping of the artery and then replacement of the dilated segment with a graft material. (See illustration)
- This was often associated with a long hospital stay and even longer convalescence at home. Today, the many aneurysms are treated with a special stent that has graft material on its surface. This is placed into the artery and used to exclude the aneurysm from the circulation, a “tube within a tube” concept. (see illustration).
- This can often be done through two small incisions or puncture sites in each groins. The patient often goes home the following day and is back to normal within a week or two
- Peripheral Aneurysm
Peripheral Arterial Disease (PAD)
Aortoiliac occlusive disease is the blockage of the aorta, the main blood vessel in your body, or the iliac arteries. The iliac arteries are the branches that your aorta divides into around the level of the belly button to provide blood to your legs and the organs in your pelvis. This blockage is typically caused by a buildup of plaque within the walls of your blood vessels.
The aorta and iliac arteries are the second most common blood vessels to be affected by peripheral arterial disease (PAD) after the blood vessels in the thigh. PAD occurs in 12-20% of people over the age of 65.
Aortoiliac occlusive disease may be managed by:
- Risk factor modification, such as quitting smoking, controlling cholesterol or high blood pressure, managing diabetes and regular exercise.
- Medication may be prescribed, such as an aspirin or another medication to prevent platelets from clotting in the blood. A statin drug may help control cholesterol and also help prevent plaque progression.
- If further treatment is needed, a minimally invasive procedure or a surgical bypass may be considered.
- The most common minimally invasive treatment is the placement of a stent in your aorta or iliac arteries. This procedure is commonly done at the same time as a catheter-directed angiogram test. The stent is a small device that 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 the treatment.
- A surgical bypass is the creation of a detour around the blockage. The detour may start in the aorta (near your heart) and may end either in the iliac arteries in your pelvis, or in an artery in your groin. A bypass may be performed either on one or both sides at the same time. For severe disease that includes the aorta and both iliac arteries, a bypass typically runs from the aorta to the groin arteries, usually using an artificial graft. If there is not a suitable artery to originate the bypass in the aorta, or if you are not healthy enough to undergo an aortic-based procedure, the bypass generally starts at the axillary artery underneath the collarbone and ends in one or both legs.
- Renovascular Conditions
- Mesenteric Ischemia