Translumbar aortography failed to show significant iliac artery disease in 28 patients, because the lesions were not oriented in profile to the x-ray film. To overcome this limitation of aortography, a hemodynamic test was designed to diagnose significant iliac occlusive disease by eliciting a pressure gradient across the iliac artery during exercise. Forty patients with intermittent claudication, whose aortograms failed to show iliac stenoses, were studied with this hemodynamic test. Seventeen of the 28 patients found to have iliac artery disease by exercise testing underwent aortoiliac reconstruction, with total relief or improvement of symptoms in 95%; 18 of the 28 patients had concomitant superficial femoral artery occlusion. This technique has helped us to avoid performing femoral-popliteal reconstruction in the patients with covert aortoiliac disease.
Moore WS, Hall AD. Unrecognized Aortoiliac StenosisA Physiologic Approach to the Diagnosis. Arch Surg. 1971;103(5):633-638. doi:10.1001/archsurg.1971.01350110135022