Aortoiliac Occlusive Disease Clinical Presentation

Updated: Aug 21, 2017
  • Author: Khanjan H Nagarsheth, MD, MBA; Chief Editor: Vincent Lopez Rowe, MD  more...
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Presentation

History and Physical Examination

The most common symptom of patients with hemodynamically significant aortoiliac disease (AIOD) is claudication (from Latin claudicatio ["limping, lameness"]). The symptom complex of claudication is defined as muscle cramps in the leg(s) that occur after exercise and are relieved by resting. In any individual patient, the exercise distance at which claudication occurs is quite constant.

Claudication usually occurs first in the calf muscles, though thigh, hip, and buttocks muscles also can be affected when more extensive proximal lesions are present. The location of the muscle pain (ie, calf vs thigh) does not necessarily correlate with the level of arterial obstruction. However, more proximal symptoms (ie, buttocks or thigh claudication) are generally associated with severe AIOD.

Symptoms of buttock claudication can occur in association with erectile dysfunction in patients with absent femoral pulses. This constellation of symptoms, termed Leriche syndrome (after the surgeon who described it in 1923), occurs when either preocclusive stenosis or complete occlusion of the infrarenal aorta is present as a result of to severe aortic atherosclerosis. Because of the chronic nature of the occlusive process leading to the development of rich collateral blood supply to the lower extremity, limb-threatening ischemia seldom occurs.