Abstract
Aortoiliac occlusive disease is a form of peripheral artery disease affecting the abdominal aorta and bilateral iliac arteries. Patients may present with standard PAD symptoms of claudication, rest pain, and tissue loss, or with Leriche syndrome. A variety of treatment options are available to the vascular surgeon, notably iliac artery stenting, endovascular aortoiliac reconstruction, aortofemoral bypass, and extra-anatomic bypass. Aortofemoral bypass provides durability with patency rates superior to those of other interventions, but these operations are also associated with increased rates of perioperative morbidity and mortality. Instead, endovascular options may be preferred in certain high-risk patients. Hybrid procedures utilizing multiple techniques may allow for lower perioperative morbidity while also providing comparable primary patency rates. This chapter highlights endovascular therapy and techniques as applied to aortoiliac disease.
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References
Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86.
Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte MS, Pomposelli FB, Clair DG, Geraghty PJ, McKinsey JF, et al.; Society for Vascular Surgery. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61:2S–41S.
Heart Protection Study Collaborative Group. Randomized trial of the effects of cholesterol-lowering with simvastatin on peripheral vascular and other major vascular outcomes in 20,536 people with peripheral arterial disease and other high-risk conditions. J Vasc Surg. 2007;45:645–54.
Greiner A, Dessl A, Klein-Weigel P, Neuhauser B, Perkmann R, Waldenberger P, et al. Kissing stents for treatment of complex aortoiliac disease. Eur J Vasc Endovasc Surg. 2003;26:161–5.
Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P, Cheung K, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20:443–55.
Jongking V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg. 2010;52:1376–83.
Moon JY, Hwang HP, Kwak HS, Han YM, Yu HC. The results of self-expandable kissing stents in aortic bifurcation. Vasc Specialist Int. 2015;31:15–9.
Mwipatayi BP, Sharma S, Daneshmand A, Thomas SD, Vijayan V, Altaf N, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2016;64:83–94.
Horejs D, Gilbert PM, Burstein S, Vogelzang RL. Normal aortoiliac diameters by CT. J Comput Assist Tomogr. 1988;12:602–3.
Pederson OM, Aslaksen A, Vik-Mo H. Ultrasound measurement of the luminal diameter of the abdominal aorta and iliac arteries in patients without vascular disease. J Vasc Surg. 1993;17:596–601.
Bosch JL, Hunink MG. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology. 1997;204:87–96.
Jacobs DL, Motaganahalli R, Cox DE, Wittgen CM, Peterson GJ. True lumen re-entry devices facilitate subintimal angioplasty and stenting of total chronic occlusions: initial report. J Vasc Surg. 2006;43:1291–6.
Scheinert D, Schmidt A. Techniques for crossing iliac and aortoiliac CTOs: using access strategies and reentry devices for successful intervention. Endovasc Today. 2011;10:39–43.
Vallabhaneni R, Sorial EE, Jordan WD, Minion DJ, Farber MA. Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair. J Vasc Surg. 2012;56:1549–54.
Papazoglou KO, Sfyroeras GS, Zambas N, Konstantinidis K, Kakkos SK, Mitka M. Outcomes of endovascular aneurysm repair with selective internal iliac artery coverage without coil embolization. J Vasc Surg. 2012;56:298–303.
Maldonado TS, Westin GG, Jazaeri O, Mewissen M, Reijnen MM, Dwivedi AJ, et al. Treatment of aortoiliac occlusive disease with the Endologix AFX unibody endograft. Eur J Vasc Endovasc Surg. 2016;52:64–74.
Goverde PC, Grimme FA, Verbruggen PJ, Reijnen MM. Covered endovascular reconstruction of aortic bifurcation (CERAB) technique: a new approach in treating extensive aortoiliac occlusive disease. J Cardiovasc Surg (Torino). 2013;54:383–87.
Taeymans K, Groot Jebbink E, Holewijn S, Martens JM, Versluis M, Goverde PC, Reijnen MM. Three-year outcome of the covered endovascular reconstruction of the aortic bifurcation technique for aortoiliac occlusive disease. J Vasc Surg. 2018;67:1438–47.
Chang RW, Goodney PP, Baek JH, Nolan BW, Rzucidlo EM, Powell RJ. Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease. J Vasc Surg. 2008;48:362–7.
Chen TW, Huang CY, Chen PL, Lee CY, Shih CC, Chen IM. Endovascular and hybrid revascularization for complicated aorto-iliac occlusive disease: short-term results in single institute experience. Acta Cardiol Sin. 2018;34:313–20.
Taurino M, Persiani F, Fantozzi C, Ficarelli R, Rizzo L, Stella N. Trans-Atlantic Inter-Society Consensus II C and D iliac lesions can be treated by endovascular and hybrid approach: a single-center experience. Vasc Endovasc Surg. 2014;48:123–8.
Huynh TT, Bechara CF. Hybrid interventions in limb salvage. Methodist Debakey Cardiovasc J. 2013;9:90–4.
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King, J.R., Maijub, J.G., Motaganahalli, R.L. (2021). Aortoiliac Occlusive Disease: Endovascular Management. In: Hoballah, J.J., Bechara, C.F. (eds) Vascular Reconstructions. Springer, New York, NY. https://doi.org/10.1007/978-1-0716-1089-3_26
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