From the Guidelines
Iliac artery stenosis typically presents with symptoms of lower extremity arterial insufficiency, most commonly intermittent claudication, characterized by cramping, aching, or fatigue in the buttocks, thighs, or calves that occurs with exercise and resolves with rest. The symptoms of iliac artery stenosis can be asymptomatic or incidentally identified on diagnostic imaging studies, but often present with claudication, which is reproducible lower-extremity pain brought on by walking or exercise and relieved by rest 1. Patients may also experience erectile dysfunction in males due to decreased blood flow to the pelvic region. As the disease progresses, more severe symptoms can develop, including:
- Rest pain (pain that occurs even without activity)
- Tissue loss with non-healing wounds or ulcers
- Gangrene in advanced cases Physical examination may reveal:
- Diminished or absent femoral pulses
- Bruits over the iliac arteries
- Pallor of the affected limb with elevation
- Dependent rubor (redness when the leg is in a dependent position)
- Delayed capillary refill The severity of symptoms correlates with the degree of stenosis and the development of collateral circulation, as noted in the study by Copelan et al 1. These symptoms occur because the narrowed iliac artery cannot deliver sufficient blood flow to meet the metabolic demands of the lower extremities, particularly during exercise when oxygen requirements increase. According to the American College of Radiology Appropriateness Criteria, the diagnosis of iliac artery occlusive disease is usually confirmed through Doppler vascular ultrasound, CT angiography, or MR angiography 1.
In terms of diagnosis and treatment, the choice of imaging modality usually depends on availability and patient comorbidities, such as chronic kidney disease 1. The Trans-Atlantic Inter-Society Consensus II classification system is commonly used to describe the extent of peripheral vascular disease. Therapeutic options for atherosclerotic disease include supportive measures, such as behavior modification and supervised exercise programs, as well as adjunctive treatment with anticoagulation and antiplatelet medications, angioplasty, stent placement, and surgical bypass 1. The CLEVER study demonstrated superior treadmill walking performance at 6-month follow-up in the supervised exercise cohort versus the primary stenting cohort for patients with claudication resulting from aortoiliac peripheral artery disease 1.
Overall, the symptoms of iliac artery stenosis are primarily related to lower extremity arterial insufficiency, and the diagnosis and treatment depend on the severity of symptoms, the degree of stenosis, and the development of collateral circulation. The most effective treatment approach often involves a combination of medical management, lifestyle modifications, and revascularization procedures.
From the Research
Symptoms of Iliac Artery Stenosis
- Buttock claudication: a condition characterized by pain or cramping in the buttocks during walking or exercise, which is relieved by rest 2, 3, 4
- Thigh claudication: pain or cramping in the thighs during walking or exercise, which is relieved by rest 2
- Localized thigh and buttock claudication: pain or cramping in the thighs and buttocks during walking or exercise, which is relieved by rest 2
Diagnosis and Treatment
- Conventional or MR-angiography is necessary to secure the diagnosis of iliac artery stenosis 3
- Percutaneous transluminal angioplasty (PTA) is a technically feasible and safe method for treating iliac artery stenosis 2, 3, 4
- Stenting may also be used to treat iliac artery stenosis, especially in cases where PTA is technically unsuccessful 5, 6
Outcomes of Treatment
- Symptom relief: the majority of patients undergoing endovascular treatment for iliac artery stenosis experience complete or partial relief of symptoms 2, 4
- Technical success rate: high technical success rates have been reported for endovascular treatment of iliac artery stenosis 2, 4
- Patency rates: high primary patency rates have been reported for endovascular treatment of iliac artery stenosis 4