Percutaneous Arterial Angioplasty with and without Stenting for Atherosclerotic Aortic and Iliac Artery Occlusive Disease

The comparative ease and success of endovascular management of aortoiliac occlusive disease (AIOD) has greatly reduced the need for its open surgical repair. Factors such as reduced patient morbidity, discomfort, and length of convalescence have resulted not only in increased acceptance by patients but often in patients’ insistence on this mode of therapy. Potential cost savings is another factor favoring endovascular treatments, although the expense of the necessary endovascular devices and implants and the not uncommon need for repeat interventions to treat recurrent disease can negate this potential advantage.

Indications

Endovascular treatment of AIOD should be considered for patients with disabling claudication or critical limb ischemia who have lesions with favorable expected results. The Trans-Atlantic Inter-Society Consensus (TASC) classification scheme, which stratifies patients into four groups according to the anatomic pattern of occlusive lesions, is useful to select patients for these interventions ( Box 1 ). Patients with type A lesions (focal stenosis of the common or external iliac arteries) have the best results, and endovascular therapy is the treatment of choice for this group. Open surgical reconstruction is recommended for patients with the most severe pattern of disease (type D lesions). Comorbidities, patient’s preference, and the operator’s experience should be considered when choosing endovascular or open techniques for managing patients with types B and C lesions, with the majority of these patients currently treated with endovascular intervention.

Box 1

TASC Classification of Aortoiliac Lesions

Type A Lesions

Unilateral or bilateral stenoses of SFA
Unilateral or bilateral single short (≤3 cm) stenosis of EIA

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