Chronic iliac aortic occlusion: Diagnosis and surgical treatment

The article was professionally consulted with Master, Doctor Bui Tien Dat - Emergency Department - Vinmec Hai Phong International General Hospital.

Chronic iliac aortic occlusion is mainly caused by atherosclerosis. If not diagnosed early and treated actively in the early stages, chronic iliac aortic occlusion can cause limb necrosis and many complications that seriously affect the patient's health.

1. Causes of chronic iliac aortic occlusion

Chronic iliac aortic occlusion is chronic occlusion of the abdominal aorta below the renal artery or chronic iliac artery occlusion.
The cause of chronic iliac aortic occlusion is mainly atherosclerosis. The main risk factors for atherosclerosis are smoking, diabetes mellitus, hypertension, dyslipidemia, and hyperhomocysteinemia. In addition, other common causes of chronic iliac aortic occlusion are fibromyalgia and Takayasu disease.

2. Complications of chronic iliac aortic occlusion

Chronic iliac aortic occlusion, if not timely intervention, will cause many serious consequences for the patient. Of these, lower extremity ischemia is the most common complication.

phù chân — Tắc động mạch chủ chậu mãn tính gây thiếu máu chi dưới

Anemia in the lower extremities can lead to necrosis of the limbs, reduced mobility, reduced working capacity, and even become disabled, becoming a burden to the family and society. A patient's limb amputation not only affects physical health, but also seriously affects mental health. Studies have shown that patients with chronic iliac artery occlusion do not die directly from limb ischemia, but die from associated cardiovascular diseases.

3. Diagnosis of chronic iliac aortic occlusion

Common symptoms of chronic iliac aortic occlusion are:
Claudication is the typical symptom, most often in the early stages of the disease. Claudication is a feeling of muscle contraction pain, appearing on exertion, after walking a certain distance, and relieved when stopping. The pain reappears when walking the same distance with the same amount of exertion. Lower extremity pain when lying down, usually occurs at night. The patient has a burning sensation but also numbness and cold extremities. Symptoms improve with slouching or standing upright. The limb with chronic ischemia has signs such as: skin and muscle atrophy, hair loss, nails dry brittle, brittle, pulse decreased or lost, surface temperature is lower than the opposite limb, the tips of the fingers are purple or necrosis, forming ulcers in the distal extremities.

Màu sắc của ngón chân — Đầu các ngón chân chi thiếu máu sẽ bị tím tái và hoại tử

In the severe stage, patients have lower extremity pain even at rest or have ulcerated, non-healing, necrotic wounds. Impotence, decreased physiological function, buttock muscle atrophy can occur when the blood vessels to nourish these parts are blocked. The imaging tools that can be used to diagnose the disease, locate the artery occlusion are Doppler ultrasound, multi-CT scan, magnetic resonance angiography and angiography. Imaging techniques will allow assessment of the location of the injured artery, the extent of the lesion, the development of an alternative collateral circulation, the characteristics of the downstream arterial bed, ... Imaging results are an important basis for doctors to prescribe treatment methods.

4. Surgical treatment of chronic iliac aortic occlusion

In patients with claudication unresponsive to medical therapy or patients with severe limb ischemia, surgery may be indicated for symptomatic relief, pain relief, ulcer healing/necrosis, and conservation. anemia, prolonging and improving the quality of life for patients.

phẫu thuật tạo van — Bệnh nhân có thể được chỉ định phẫu thuật để bảo tồn chi thiếu máu

Surgical interventions that can be performed are:
Surgical removal of plaque in the artery lumen: Then using a vein patch or an artificial vessel to widen the artery lumen at the site of the atheroma removal. Arterial bypass surgery: Using a bridge with a saphenous vein or an artificial vessel. The commonly performed artery bypass surgery are: iliac-femoral artery bypass, bilateral abdominal-pelvis aorta, bilateral thoracic-femoral bridge, axillary-femoral artery bypass, lateral femoral-femoral artery bypass,... Angioplasty of the narrowed artery with a balloon, may or may not be accompanied by stenting. Amputation is indicated when chronic iliac aortic occlusion is severe with extremity necrosis or the results of intervention, surgery fail. Try to reattach the foot rest or at least the knee joint to create a stump for rehabilitation.

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Bài viết này được viết cho người đọc tại Sài Gòn, Hà Nội, Hồ Chí Minh, Phú Quốc, Nha Trang, Hạ Long, Hải Phòng, Đà Nẵng.