New techniques to assess aortoiliac stenosis

The clinical assessment of aortoiliac occlusive disease begins with the history and physical examination. Patients with significant hip or thigh claudication should be considered to have hemodynamically significant aortoiliac occlusive disease until proven otherwise. The absence of a femoral pulse should not present a diagnostic dilemma; in the presence of a normal femoral pulse and a bruit over the iliac or common femoral artery, however, the clinician must determine whether or not hemodynamically significant aortoiliac stenosis exists. Unfortunately, a single-plane contrast arteriogram does not document the physiologic significance of aortoiliac occlusive disease. Some patients may have minimal angiographic abnormalities but nevertheless suffer from severe inflow obstruction to the extremity. On the other hand, many patients with significant arterial lesions on arteriogram have no significant obstruction to blood flow to the extremities