Iliac Artery - Occlusion, Stenosis, Aneurysm

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Iliac artery

The iliac artery is the largest paired blood vessel after the aorta, five to seven centimeters long and 11-13 mm in diameter. The arteries begin at the site of the bifurcation of the aorta, at the level of the fourth lumbar vertebra. At the junction of the ilium and the sacrum, they break up into the external and internal iliac arteries.

The internal artery splits into branches - the middle rectal, iliopsoas, sacral, lateral, lower and upper gluteal, lower urinary, internal genital, obturator. They deliver blood to the organs and inner walls of the pelvic cavity.

The external artery, leaving the pelvic cavity, simultaneously gives off several branches to its walls and continues in the form of a femoral artery in the region of the lower extremities. Branches of the femoral artery (deep artery, inferior epigastric artery) carry blood to the skin and muscles of the thighs, and then branch out into smaller arteries and provide blood supply to the foot and lower leg.

In men, the iliac artery delivers blood to the testicular membranes, thigh muscles, bladder, and penis.

Iliac artery aneurysm

An aneurysm of the iliac artery is a saccular protrusion of the vessel wall. The wall of the artery gradually loses its elasticity and is replaced by connective tissue. The causes of aneurysm formation can be hypertension, trauma, atherosclerosis.

An aneurysm of the iliac artery can proceed without any special symptoms for a long time. Pain syndrome at the site of the aneurysm occurs if it, reaching large sizes, begins to squeeze the surrounding tissue.

A ruptured aneurysm can cause gastrointestinal bleeding of unknown etiology, a drop in blood pressure, a decrease in heart rate, and collapse.

Violation of the blood supply in the area of the aneurysm can lead to thrombosis of the femoral artery, lower leg arteries, and vessels of the pelvic organs. Blood flow disorders are accompanied by dysuric disorders, pain. Thrombus formation in the arteries of the lower leg sometimes leads to the development of paresis, intermittent claudication and the appearance of sensitivity disorders.

Aneurysm of the iliac artery is diagnosed using ultrasound with duplex scanning, computed tomography, MRI, angiography.

Iliac artery occlusion

Occlusion and stenosis of the iliac artery most often occurs due to thromboangiitis obliterans, atherosclerosis of the arteries, fibromuscular dysplasia, aortoarteritis.

With stenosis of the iliac artery, tissue hypoxia develops, disrupts tissue metabolism. A decrease in oxygen tension in tissues leads to metabolic acidosis and the accumulation of under-oxidized metabolic products. In this case, the aggregation and adhesive properties of platelets increase, and the disaggregation properties decrease. The viscosity of the blood increases, and this inevitably leads to the formation of blood clots.

There are the following types of occlusion of the iliac arteries (depending on etiology): nonspecific aortitis, mixed form of arteritis, aortitis and atherosclerosis, iatrogenic, postembolic, post-traumatic occlusions. Depending on the nature of the lesion, chronic occlusion, acute thrombosis, and stenosis are distinguished.

Occlusion of the iliac arteries is accompanied by the appearance of a number of syndromes. The syndrome of ischemia of the lower extremities manifests itself in the form of paresthesia, easy fatigue and intermittent claudication, numbness and chilliness of the lower extremities. The syndrome of impotence is manifested in ischemia of the pelvic organs and chronic circulatory failure of the lower spinal cord.

Conservative treatment of occlusion of the iliac arteries is used to normalize blood coagulation processes, relieve pain, expand collaterals and relieve vascular spasms.

In the case of conservative therapy of the affected vessels, the following drugs can be used:

• ganglion-blocking agents (midocalm, bupatol, vasculate);
• pancreatic agents (dilminal, angiotrophin, andecalin);
• antispasmodic drugs (no-shpa, papaverine).

The indications for surgical intervention are:

• severe intermittent claudication or pain at rest;
• necrotic changes in the tissues of the limb (urgent surgery);
• embolism of large and medium arteries (emergency operation).

Methods for surgical treatment of occlusion of the iliac arteries:

• resection of the affected area of the artery and its replacement with a graft;
• endarterectomy - opening the lumen of an artery and removing plaque;
• combination of shunting and resection with endarterectomy;
• lumbar sympathectomy.

Currently, the method of X-ray endovascular dilation is often used to restore stenotic arteries. This method is successfully used as an adjunct to reconstructive operations for multiple vascular lesions.

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