REVIEW Anatomical Significance in Aortoiliac Occlusive Disease CANDACE WOOTEN, 1 MUNAWAR HAYAT, 2 MAIRA DU PLESSIS, 3 ALPER CESMEBASI, 3,4 MICHAEL KOESTERER, 3 KEVIN P. DALY, 5 PETRU MATUSZ, 6 R. SHANE TUBBS, 7 AND MARIOS LOUKAS 3,8* 1 Department of Family Medicine, University of Louisville, Louisville, Kentucky 2 Department of Family Medicine, University of Texas-Southwest, Dallas, Texas 3 Department of Anatomical Sciences, St. George’s University, Grenada, West Indies 4 Departments of Neurologic and Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 5 Department of Vascular and Interventional Radiology, Tufts Medical Center, Boston, Massachusetts 6 Department of Anatomy, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania 7 Department of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama 8 Department of Anatomy, Medical School Varmia and Mazuria, Olsztyn, Poland Aortoiliac occlusive disease is a subset of peripheral arterial disease involving an atheromatous occlusion of the infrarenal aorta, common iliac arteries, or both. The disease, as it is known today, was described by the French surgeon Ren  e Leriche as a thrombotic occlusion of the end of the aorta. Leriche successfully linked the anatomic location of the occlusion with a unique triad of symptoms, including claudication, impotence, and decreased peripheral pulses. The anatomi- cal location of the atheromatous lesions also has a direct influence on classification of the disease, as well as choice of treatment modality. Considering its impact on diagnosis and treatment, we aimed to provide a detailed understanding of the anatomical structures involved in aortoiliac occlusive disease. Familiarity with these structures will aid the physician in interpretation of radiologic images and surgical planning. Clin. Anat. 27:1264–1274, 2014. V C 2014 Wiley Periodicals, Inc. Key words: aortoiliac occlusive disease; Leriche syndrome; aortoiliac occlu- sion; aortic atherosclerosis; peripheral arterial disease; intermit- tent claudication; Rene Leriche INTRODUCTION Peripheral arterial disease (PAD) is part of a broad spectrum of atherosclerotic cardiovascular diseases that affect the coronary, cerebrovascular, visceral, aortoiliac, and infrainguinal vascular beds. Aortoiliac occlusive disease is a subset of PAD involving an ath- eromatous occlusion of the infrarenal aorta, common iliac arteries, or both. The exact incidence and preva- lence of the condition is difficult to ascertain; many patients are asymptomatic as a result of the develop- ment of collateral networks. However, PAD alone has an estimated prevalence as high as 14.5% in individu- als above the age of 70 (Gornik and Creager, 2007). Aortoiliac occlusive disease was first described in 1814 by Robert Graham (1786–1845), physician at the Royal Infirmary in Glasgow (Graham, 1814). Despite this earlier description, the disease as it is known today was described by the French surgeon Ren  e Leriche in 1923. He described the condition as a thrombotic disease of the end of the aorta that was associated with a unique triad of symptoms, including Contract grant sponsor: Department of Anatomical Sciences, St. George’s University, Grenada, West Indies. *Correspondence to: Marios Loukas, M.D., Ph.D., Department of Anatomical Sciences, St. George’s University, School of Medi- cine, Grenada, West Indies. E-mail: mloukas@sgu.edu Received 12 March 2014; Revised 27 June 2014; Accepted 2 July 2014 Published online 25 July 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22444 V V C 2014 Wiley Periodicals, Inc. Clinical Anatomy 27:1264–1274 (2014)