Answer for CoW 31 Dec 2017
Aortoiliac Occlusive Disease
Findings
Eccentric atheromatous plaque noted in left lateral wall of infra-renal aorta with extension into bilateral common iliac arteries (L>R) Complete occlusion of left common iliac artery noted with attenuated flow in left external iliac artery. Normal flow reconstituted at femoral artery. Complete occlusion of left popliteal artery noted with reconstituted flow in left anterior & posterior tibial arteries. Left peroneal artery shows attenuated flow.
Discussion
Aortoiliac occlusive disease refers to occlusion of the aorta distal to the renal arteries. When the clinical triad of impotence, pelvis and thigh claudication, and absence of the femoral pulses are present, it may also be called Leriche syndrome, which usually affects younger (30-40 year old) males Aortoiliac occlusive disease is more common in the elderly with an advanced atherosclerotic disease. Most often the occlusion occurs near the aortic bifurcation. It typically begins at the distal aorta or common iliac artery origins and slowly progresses proximally and distally over time. The main cause of this syndrome is an atherosclerotic obstruction of aortoiliac arteries. Other causes include vasculitis & thrombosis. An extensive network of collateral parietal and visceral vessels may form to bypass any segment of the aortoiliac arterial system. In abdominal aortoiliac stenosis and occlusion, the most commonly occurring collateral pathways to the lower extremities are superior mesenteric artery > inferior mesenteric artery > superior rectal artery > middle and inferior rectal arteries > external iliac arteries.
Findings
Eccentric atheromatous plaque noted in left lateral wall of infra-renal aorta with extension into bilateral common iliac arteries (L>R) Complete occlusion of left common iliac artery noted with attenuated flow in left external iliac artery. Normal flow reconstituted at femoral artery. Complete occlusion of left popliteal artery noted with reconstituted flow in left anterior & posterior tibial arteries. Left peroneal artery shows attenuated flow.
Discussion
Aortoiliac occlusive disease refers to occlusion of the aorta distal to the renal arteries. When the clinical triad of impotence, pelvis and thigh claudication, and absence of the femoral pulses are present, it may also be called Leriche syndrome, which usually affects younger (30-40 year old) males Aortoiliac occlusive disease is more common in the elderly with an advanced atherosclerotic disease. Most often the occlusion occurs near the aortic bifurcation. It typically begins at the distal aorta or common iliac artery origins and slowly progresses proximally and distally over time. The main cause of this syndrome is an atherosclerotic obstruction of aortoiliac arteries. Other causes include vasculitis & thrombosis. An extensive network of collateral parietal and visceral vessels may form to bypass any segment of the aortoiliac arterial system. In abdominal aortoiliac stenosis and occlusion, the most commonly occurring collateral pathways to the lower extremities are superior mesenteric artery > inferior mesenteric artery > superior rectal artery > middle and inferior rectal arteries > external iliac arteries.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!