Ultrasound Scan:
Vein Mapping

Aortoiliac artery disease, also known as aortoiliac occlusive disease or aortoiliac arteriosclerosis, refers to a condition characterised by the narrowing or blockage of the aortoiliac arteries. These arteries are major blood vessels that supply oxygenated blood to the lower abdomen, pelvis, and legs. The most common cause of aortoiliac artery disease is atherosclerosis, which is the buildup of plaque consisting of cholesterol, fatty deposits, and other substances on the inner walls of the arteries. Over time, this plaque can harden and narrow the arterial lumen, restricting blood flow to the affected regions. Prior to the artery completely blocking, the narrowing (or stenosis) progresses over time and amplifies your symptoms. The symptoms of a narrowing tends to start with pain in the legs when walking short distances. This can progress to rest pain which occurs when the blood flow trying to move towards your feet is insufficient while you are laying flat; but on sitting up gravity can assist the blood to the foot providing relief.

This scan usually takes between 20-30 minutes to complete.

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This ultrasound will require direct contact with the upper arm and forearm as well as the legs from the groin crease to the ankle.

For the arms we will require for you to remove your jumper and long sleeve shirts; short sleeve shirts don't need to be removed. We will place a tourniquet on the upper arm to dilate the veins as much as possible. We will the apply ultrasound gel and scan from the upper arm all the way down to the wrist.

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For your legs we will need you to remove your trousers or shorts. We will keep you sitting in an upright position to allow the veins to dilate as much as possible. We will apply ultrasound gel and scan from the groin crease all the way down to the ankle.

Vein Mapping studies involves the assessment of the arm veins (cephalic and basilic veins) and lower leg veins (great saphenous veins and short saphenous veins). The purpose of this study is to measure the maximum diameters of the veins to determine which ones would be suitable to use as a conduit for surgery. This could be used as a patch for an endarterectomy procedure, a vein bypass graft to direct blood flow around a blockage in the arms, legs or heart or an interposition graft.

Aortoiliac artery disease, also known as aortoiliac occlusive disease or aortoiliac artery stenosis, involves the narrowing or blockage of the aorta or iliac arteries, which are major blood vessels supplying the lower abdomen, pelvis, and lower extremities. Several risk factors are associated with the development of aortoiliac artery disease. These risk factors include:

Age

Aortoiliac artery disease becomes more prevalent with advancing age. The risk increases significantly in individuals over the age of 60.

Smoking

Smoking is a major modifiable risk factor for aortoiliac artery disease. The toxins in tobacco smoke can damage the arterial walls and accelerate the progression of atherosclerosis, a condition characterised by the buildup of plaque in the arteries.

Diabetes

Individuals with diabetes have an increased risk of developing aortoiliac artery disease. Diabetes can lead to metabolic abnormalities and promote the development of atherosclerosis.

Hypertension

High blood pressure can contribute to the development and progression of aortoiliac artery disease. Elevated blood pressure places increased stress on the arterial walls, potentially leading to damage and atherosclerosis.

Hyperlipidemia

Elevated levels of cholesterol and triglycerides in the blood, often associated with hyperlipidemia, are known risk factors for aortoiliac artery disease. High levels of LDL cholesterol ("bad" cholesterol) can contribute to the formation of arterial plaques.

Obesity

Excess body weight, particularly abdominal obesity, increases the risk of aortoiliac artery disease. Obesity is associated with a higher likelihood of developing atherosclerosis and related cardiovascular conditions.

Family history

Having a family history of aortoiliac artery disease or other vascular conditions increases the risk of developing the disease. Genetic factors can influence an individual's susceptibility to atherosclerosis and arterial blockages.

Sedentary lifestyle

Lack of physical activity and a sedentary lifestyle contribute to several cardiovascular risk factors, including obesity, hypertension, and dyslipidemia, all of which can increase the risk of aortoiliac artery disease.

Other medical conditions

Certain medical conditions, such as chronic kidney disease, peripheral artery disease (PAD), and coronary artery disease (CAD), are associated with a higher risk of developing aortoiliac artery disease.

A question almost always asked is 'what happens to the blood flow if they remove a vein and put it somewhere else? Arteries provide oxygenated blood to the extremities; veins carry the deoxygenated blood back to the heart. We have more than one artery and one vein providing this circulation. When harvesting a vessel for a bypass or patch procedure, it is usually a vein that is taken. In terms of the veins; we have a set of 'deep veins' and 'superficial veins'. The veins removed are the superficial veins and the deep veins remain untouched. Without the superficial vein present the blood flow moves through only the deep venous system instead.

The treatment options for aortoiliac artery disease, also known as aortoiliac occlusive disease or aortoiliac artery stenosis, depend on the severity of symptoms, the extent of arterial blockage, and individual patient factors. The primary goals of treatment are to relieve symptoms, improve blood flow, and reduce the risk of complications. Here are some common treatment options for aortoiliac artery disease:

Lifestyle modifications: Making certain lifestyle changes can help manage aortoiliac artery disease and reduce the progression of atherosclerosis. These may include smoking cessation, adopting a healthy diet low in saturated fats and cholesterol, engaging in regular exercise, and maintaining a healthy weight.

Medications: Medications may be prescribed to manage risk factors associated with aortoiliac artery disease. These can include:

• Antiplatelet agents: Medications such as aspirin or clopidogrel may be prescribed to reduce the risk of blood clot formation and improve blood flow.

• Cholesterol-lowering medications: Statins or other lipid-lowering medications may be prescribed to manage high cholesterol levels and slow down the progression of atherosclerosis.

• Blood pressure control: Medications to control hypertension may be prescribed to reduce blood pressure and minimize the risk of further arterial damage.

Endovascular procedures:

• Angioplasty and stenting: This minimally invasive procedure involves the insertion of a balloon-tipped catheter into the narrowed or blocked artery. The balloon is inflated to widen the artery, and a stent (a small mesh tube) may be placed to keep the artery open and improve blood flow.

Bypass surgery: In severe cases of aortoiliac artery disease or when endovascular procedures are not suitable or effective, bypass surgery may be considered. This involves creating a detour around the blocked or narrowed artery using a graft (artificial or natural blood vessel) to restore blood flow to the lower extremities.

Thrombolytic therapy: In cases where there is a blood clot (thrombus) causing significant arterial blockage, thrombolytic therapy may be used. Medications are administered intravenously to dissolve the clot and restore blood flow.

The choice of treatment depends on several factors, including the severity of the disease, the presence of symptoms, the extent of arterial blockage, and individual patient characteristics.