Endovascular management of iliac artery occlusions: extending treatment to TransAtlantic Inter-Society Consensus class C and D patients

Abstract

Complex long-segment and bilateral iliac occlusions can be safely treated via endovascular means with high rates of symptom resolution. Initial technical success, low morbidity, and mid-term durability are comparable to results with open reconstruction. A liberal posture to open femoral artery reconstruction extends the ability to treat diffuse TASC-C and -D lesions via endovascular means.

Two-Year Primary Patency Rates After Aortoiliac Occlusive Disease Endovascular Treatment

“…Two-year primary patency rates were 96.3%, 100%, 66.7%, and 81.6% for A -D TASC subtypes, respectively. Traditionally TASC C and D lesion were known to be treated successfully with open surgery, but there were reports about high primary patency rate (ranging 72% -89%) even in these patients after endovascular treatment (28,29). Grimme et al investigated primary patency rates in patients with TASC C/ D aortoiliac lesions treated with either endovascular or surgery treatment and reported that the primary patency rates at 1 and 2 years were 83% and 79.9% after endovascular stenting and 97.1% and 97.1% after surgical approach (27).…”

Using Intermittent Pneumatic Compression Therapy to Improve Quality of Life for Symptomatic Patients With Infrapopliteal Diffuse Peripheral Obstructive Disease

“…[29][30][31] According that classification, however, there is a lack of the data on PTA for distal lower limb arteries such as the peroneal, posterior tibial, and dorsalis pedis arteries. Furthermore, it notes insufficient information for PTA in diffuse lesions throughout previous studies.…”

SCAI expert consensus statement for aorto‐iliac arterial intervention appropriate use

“…The stent data for more complex lesions such as TASC C/D and other CTO lesions are also encouraging (Table II) [14,18,19,22,24]. According to two recent meta-analyses [18,19], immediate technical success rates for aorto-iliac intervention exceed 90%, with 4-5 year primary patency rates of 60-86%, secondary patency rates of 80-98%, and limb salvage rates of 98%.…”

“…One option is to perform a hybrid procedure with open femoral endarterectomy (with or without profundoplasty) followed by iliac stenting [6,14,34]. This hybrid approach limits the open surgery to the groin and avoids complications associated with aortic cross clamping and laparotomy [14,24].…”