In medicine, aortoiliac occlusive disease is a form of central artery disease involving the blockage of the abdominal aorta as it transitions into the common iliac arteries. Signs and symptoms
Classically, it is described in male patients as a triad of the following signs and symptoms:
claudication of the buttocks and thighs
absent or decreased femoral pulses
erectile dysfunctionThis combination is known as Leriche syndrome. However, any number of symptoms may present, depending on the distribution and severity of the disease, such as muscle atrophy, slow wound healing in the legs, and critical limb ischemia. Diagnosis
The physical examination usually shows weakened femoral pulses and a reduced ankle-brachial index. The diagnosis can be verified by color duplex scanning, which reveals either a peak systolic velocity ratio ≥2.5 at the site of stenosis and/or a monophasic waveform. MRA and multidetector CTA are often used to determine the extent and type of obstruction. Another technique is digital subtraction angiography which allows verification of the diagnosis and endovascular treatment in a single session. Angiography provides important information regarding the perfusion and patency of distal arteries (e.g. femoral artery). The presence of collateral arteries in the pelvic and groin area is important in maintaining crucial blood flow and lower limb viability. However, angiography should only be used if symptoms warrant surgical intervention. Treatment
Treatment involves revascularization typically using either angioplasty or a type of vascular bypass
Kissing balloon angioplasty +/- stent, so named because the two common iliac stents touch each other in the distal aorta.
Transsexual people experience a gender identity that is inconsistent with their assigned sex, and desire to permanently transition to the sex or gender with which they identify, usually seeking medical assistance (including sex reassignment therapies, such as hormone replacement therapy and sex reassignment surgery) to help them align their body with their identified sex or gender. The term transsexual is a subset of transgender, but some transsexual people reject the label of transgender. A medical diagnosis of gender dysphoria can be made if a person experiences marked and persistent incongruence between their experienced gender — their personal sense of their own gender — and their assigned sex. Understanding of transsexuality has changed very quickly in the 21st century. Many 20th century medical beliefs and practices around transsexuality are now considered deeply outdated. It was once classified as a mental disorder and subject to extensive gatekeeping by the medical establishment, and remains so in much of the world. Terminology
Transsexual has had different meanings throughout time. In modern usage, it refers to "a person who desires to or who has modified their body to transition from one gender or sex to another through the use of medical technologies such as hormones or surgeries." It is considered an antiquated term, and is sometimes pejorative. The general shift is to instead use the term transgender or the abbreviated form trans, but due to its historical usage, transsexual remains in the modern vernacular. : 742–744  In understanding the subject, it is noted that there is a difference between gender and sex.