Iliac Artery Stenosis

The iliac artery originates from the aorta and forms the arteries leading into the pelvis. The iliac then splits into the internal and external branches as it forms the femoral artery. When a patient has a significant narrowing in the iliac artery, the blood supply to the entire leg is affected. This situation, known as "inflow disease," can be an important cause of limb pain in patients with peripheral vascular disease. It is not uncommon to find both iliac arteries narrowed on each side in roughly the same location. When this happens at the origin of both of the iliac arteries, symptoms will be severe in both legs; it is equivalent to occlusion of the aorta. Typical symptoms of occlusive iliac arterial disease can be severe limb pain when walking, especially in the hips and buttocks. The pain can be cramp-like, or can be quite atypical, such as weakness in the legs with exertion. Disease above or involving the internal iliac artery may result in impotence in males. Often the opposite side can develop a rich collateral network that will continue to supply blood adequately. When both sides are involved, symptoms can be extreme.
Treatment of iliac occlusive disease is often highly successful. For complete occlusions, a surgical bypass is often needed, but complex stent procedures can be successful. For lesions that are amenable to stent implantation, there is a high rate of success, and the risk of complications is relatively low. Patients are often discharged the same day and can then walk without pain. Patients with PAD need medical treatment to reduce their risk of heart attack and stroke. This treatment includes a daily aspirin, good control of blood pressure, cholesterol lowering and smoking cessation.