Obliterative disease of the abdominal aorta and iliac arteries with intermittent claudication.
BENJAMIN BRODIE (1846) described obliteration of the iliac artery in two illustrative cases of senile gangrene, and Charcot (1858) based his original description of intermittent claudication on a patient in whom he had found at necropsy an aneurysm and obstruction of the common iliac artery. Obliterative arterial disease affecting vessels proximal to the inguinal ligament has been recognized since then as a possible cause of this symptom, but references in the literature to obstruction of the iliac arteries are few. Chabanier and Porin (1932) reported a patient with gangrene of the extremities and absence of pulsations in the legs on oscillography, who at post-mortem proved to have thrombotic obliteration of both common iliac vessels. Linton (1943) described a case of sudden thrombosis of the left external iliac artery. This event followed an operation for the removal of an ovarian tumour, when the left internal iliac artery was tied. The patient made a good recovery, and two and a half years later complained only of some fatigue of the left leg after walking one mile. Leriche (1946) discussed cases of iliac arterial obstruction, and Leriche, Kunlin, and Boely (1950), in a paper on aortography, showed several examples of the condition, without giving clinical details. Allen, Barker, and Hines (1946) stated that occlusion of the iliac arteries might be a cause of intermittent claudication, but did not record its incidence or give details of their cases. Lindbom (1950), in a careful radiological study, found it in 8 per cent, of 76 patients with intermittent claudication. Boyd, Ratcliffe, Jepson, and James (1949) and Boyd (1950), in a series of 1,000 cases of intermittent claudication, did not report obstruction of the iliac arteries. Thrombosis of the external iliac artery following lower abdominal injury in young men has recently been described by Boyd and Jepson (1950). In their cases recovery was rapid and the outlook was good, presumably because, in the absence of chronic arterial disease, an excellent collateral circulation developed. References in the literature to obliterative disease of the abdominal aorta have been more numerous. Graham, in a communication to the MedicoChirurgical Society of London in 1814, referred to a pathological specimen belonging to Allan Burns which showed the aorta and iliac vessels plugged with laminated clot; no clinical details of the case were given. Welch, in 1909, collected from the literature 59 examples of obstruction of the lower abdominal 1 Received June 20, 1951.