Iliac artery occlusion treatment encompasses the relief of stenosis or occlusion in the main vessels supplying blood to the legs.
Iliac Artery Anatomy#
The iliac arteries are formed when the abdominal aorta divides into two main branches at the L4-L5 level.
Anatomical Structure:
Abdominal Aorta
↓
Common Iliac Artery
↓
┌──┴──┐
↓ ↓
Internal External
Iliac Iliac
↓ ↓
Pelvic Femoral Artery
organs (Leg)
Clinical Significance:
- Common iliac artery: Aorto-iliac disease
- External iliac artery: Leg blood flow
- Internal iliac artery: Pelvis, hip, erectile function
Causes of Iliac Artery Disease#
Primary Causes#
Atherosclerosis (95%):
- Most common cause
- Plaque buildup
- Calcification
Risk Factors#
| Risk Factor | Effect |
|---|---|
| Smoking | Most important risk factor |
| Diabetes | 4-fold increased risk |
| Hypertension | Endothelial damage |
| Hyperlipidemia | Plaque formation |
| Age >50 | Natural process |
Other Causes#
- Aortic dissection
- Trauma
- Vasculitis
- Radiation
TASC II Classification#
Anatomical classification of iliac lesions:
| TASC | Lesion Type | Preferred Treatment |
|---|---|---|
| A | Unilateral CIA/EIA <3 cm stenosis | Endovascular |
| B | 3-10 cm stenosis, unilateral occlusion | Endovascular |
| C | Bilateral stenosis, unilateral EIA occlusion | Endovascular/Surgery |
| D | Aorto-iliac occlusion, diffuse disease | Surgery (primarily) |
Symptoms of Iliac Artery Disease#
Claudication (Intermittent Limping)#
Most common symptom:
- Leg/hip pain when walking
- Improves with rest
- Starts at a certain distance
- Leriche syndrome (bilateral)
Leriche Syndrome#
Bilateral aorto-iliac occlusion triad:
- Bilateral hip and leg claudication
- Erectile dysfunction
- Absence of femoral pulses
Critical Limb Ischemia#
Advanced stage disease:
- Rest pain
- Trophic changes
- Non-healing wounds
- Gangrene risk
Diagnostic Methods#
Physical Examination#
- Femoral pulse assessment
- ABI (Ankle-Brachial Index) measurement
- Bruit check
Imaging#
Doppler Ultrasound:
- First line
- Flow velocities
- Stenosis localization
CT Angiography:
- Detailed anatomical imaging
- Calcification assessment
- Treatment planning
MR Angiography:
- Non-contrast option
- Soft tissue detail
DSA (Digital Subtraction Angiography):
- Gold standard
- Same-session treatment
Endovascular Treatment#
Balloon Angioplasty#
Indications:
- Short segment stenosis
- Non-calcified lesions
- Focal disease
Iliac Stenting#
Primary treatment method:
Stent Types:
| Type | Feature | Indication |
|---|---|---|
| Balloon-expandable | Precise placement | Ostial, calcified |
| Self-expanding | Flexibility | Long segment, tortuous |
| Covered stent | Wall support | Rupture, aneurysm |
Technical Success: >95%
Kissing Stent Technique#
For aorto-iliac bifurcation lesions:
- Bilateral simultaneous stenting
- Preservation of aortic bifurcation
- Long-term patency: 85-90% (5 years)
Hybrid Procedures#
Endovascular + Surgical combination:
- Iliac stent + Femoral endarterectomy
- For complex disease
- Less invasive approach
Treatment Outcomes#
Primary Patency Rates#
| Lesion | 1 Year | 5 Years |
|---|---|---|
| TASC A/B | 95% | 85% |
| TASC C | 90% | 75% |
| TASC D | 85% | 70% |
Clinical Improvement#
- Claudication distance: Average 3-4 fold increase
- Quality of life: Significant improvement
- Amputation risk: Significant reduction
Complications#
Early Complications#
| Complication | Frequency | Management |
|---|---|---|
| Access site hematoma | 3-5% | Compression |
| Distal embolization | 1-2% | Aspiration/Thrombolysis |
| Rupture | <1% | Covered stent |
| Dissection | 2-3% | Stenting |
Late Complications#
- In-stent restenosis: 5-10% (per year)
- Stent fracture: Rare
- Thrombosis: Antiplatelet non-compliance
Medical Treatment#
Basic Approach#
Medical optimization in all patients:
- Antiplatelet: Aspirin ± Clopidogrel
- Statin: LDL <70 mg/dL target
- Blood pressure: <140/90 mmHg
- Diabetes control: HbA1c <7%
Lifestyle Modifications#
- Smoking cessation: Most important intervention
- Exercise program: Supervised walking
- Diet: Low fat, low salt
Surgical Treatment#
Indications#
- If endovascular treatment not suitable
- TASC D lesions
- Failed endovascular intervention
Surgical Options#
- Aorto-bifemoral bypass: Standard
- Ilio-femoral bypass: Unilateral
- Axillo-femoral bypass: High-risk patients
Follow-up Protocol#
Regular Check-ups#
- 1 month: Clinical evaluation
- 6 months: Doppler US + ABI
- Annual: CT Angiography (if needed)
Medication Compliance#
- Antiplatelet therapy: Lifelong
- Statin: Lifelong
- Risk factor control: Continuous
Frequently Asked Questions#
What is the iliac artery and why does it become blocked?
What are the symptoms of iliac artery occlusion?
How is iliac artery occlusion treated?
Is iliac stenting risky?
Can normal life resume after treatment?
Appointment and Contact#
To schedule an appointment for iliac artery disease evaluation and treatment:
📍 Eurasia Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Peripheral Interventions#
Other services related to iliac artery treatment:
- Lower Extremity Arterial Disease - Leg vessel treatment
- Peripheral Angiography - Vascular imaging
- Abdominal Aortic Aneurysm - Aortic treatment
- EVAR - Endovascular aneurysm repair
- Carotid Stenosis - Neck vessel treatment