XVII.2 Endovascular Management of Iliac Artery (TASC C and D Lesions): When Should They Be Treated by Percutaneous Transluminal Angioplasty and Stenting and When by Open Bypass?

摘要

The traditional approach to aortoiliac occlusive disease consisted of endarterectomy or, more commonly, aortofemoral, iliofemoral, and femorofemoral bypass.1'2 Despite excellent long-term durability, the use of open revascularization of aortoiliac occlusive disease has waned in recent years with improvements in endovascular techniques. Initial treatment of the aortoiliac segment with percutaneous techniques began with short focal stenosis or occlusions after sub-optimal angioplasty.3"5 In recent years, all types of aortoiliac lesions, from short focal stenosis to complete aortoiliac occlusions from the level of the renal arteries down, have been successfully treated with endovascular means. The long-standing question has been the long-term durability of endoluminal techniques for TransAtlantic Intersocietal Consensus (TASC) Class C and D lesions.6 Recent reports looking at outcomes in long lesions have found durability comparable to open reconstruction, with primary, primary assisted, and secondary patency rates ranging from 60 to 90% at 5 years. We have found that the addition of open femoral endarterectomy allows endovascular treatment of all patients' aortoiliac occlusive disease and improves outcomes.