Epidemiology

• The infrarenal abdominal aorta and the iliac arteries are the sites most commonly affected by atherosclerosis in patients with ischaemic peripheral atherosclerotic disease [10].

• The true prevalence of AIOD is unknown because it is frequently asymptomatic.

• Chronic occlusion of the infrarenal aorta (Fig. 5.5.1) is rare - reported in only 0.15% of autopsies [23]. In contrast, asymptomatic stenosis and chronic aortoiliac occlusion are present in about 55% of patients affected by symptomatic pathology of the coronary circulation [18].

• In addition, surgical or endovascular treatment of AIOD represents about 48% of all inferior limb revascularizations [17]. This percentage rises to 55% when patients younger than 40 years old are considered [22].

• Patients with type I lesions are usually relatively young, heavy smokers and present a minor prevalence of diabetes and hypertension. Among them a hyperlipi-daemia is frequent and there is no difference between male and female gender.

• SAS is more common in women, usually about 50 years old, heavy smokers, with high aortic bifurcation and a history of surgical or post-radiation premature menopause.

• Patients with type II and type III lesions are older (>60 years old), usually diabetic and hypertensive and have multilevel atherosclerotic disease (cerebral artery, coronary and visceral artery).

Fig. 5.5.1 Chronic juxtarenal aortic occlusion

• Males are involved sixfold more frequently than females.

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