Aorto-iliac lesions account for about one-third of the predominant lesions in patients with peripheral arterial disease. Claudication is the most prevalent symptom. Thanks to improvements in materials and techniques endovascular therapy has become the standard of care as the primary treatment in the vast majority of these lesions. Even in the presence of more extensive disease, excellent results can be obtained that rival those obtained with open surgery. Endovascular treatment has the advantage of being less invasive and is associated with lower periprocedural mortality and major morbidity rates.
Angioplasty alone is indicated in non-ostial stenotic lesions. Stenting is indicated in more extensive lesions, in occlusions, when the result of angioplasty is not satisfactory or when the chance for early restenosis is high such as in ostial or highly calcified eccentric lesions. Balloon-expandable and self-expandable stents yield about the same results, and the choice between both should therefore be based on the intrinsic properties of the stents and the characteristics of the lesion. The precise place of covered stents remains to be determined.
Complications related to the procedure are rare and can often be avoided by careful planning and meticulous technique. Most of the complications can be treated endovascularly.
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