Abdominal Aorta: The Surgical Approach

Abstract

Stenosis and occlusion of the lower aorta and the iliac segment is caused by atherosclerosis in more than 90% of cases. In about 20%–30%, the atherosclerotic and stenosing process is limited to the aortic and iliac axis, the remaining 70%–8o% being multilevel disease. A combination with peripheral occlusions is determined mainly by concomitant risk factors such as diabetes mellitus, hyperlipidemia, hypertension, smoking, and chronic renal disease requiring hemodialysis. Peripheral arterial occlusive disease may be regarded as a harbinger of coronary artery disease and cerebrovascular disease. Depending on the extent to which and how severely the peripheral perfusion is compromised, a number of therapeutic concepts can be implemented. Initially, for a majority of patients, conservative therapy consisting primarily of walking exercise and secondary prevention is indicated to avoid revascularization or to prevent the loss of a limb. Roughly one fourth of all patients presenting with the symptoms of lower limb ischemia will require an invasive intervention for peripheral revascularization (endo-vascular or open surgical).