Re-entry device use in the endovascular treatment of aorto-iliac occlusive disease.
The treatment of peripheral arterial occlusive disease with endovascular therapy is rapidly becoming the standard of care. Akin to the movement towards percutaneous coronary interventions that occurred with gusto throughout the 1980s and 1990 s, treatment for the peripheral vasculature has undergone its own paradigm shift. Such that many feel that a first-line catheter-based approach is justified for the majority of patients in 2012. Extensive occlusive disease of the aorto-iliac segment is an area where open surgery has historically been preferred over endovascular therapy. This is partly because the open surgical standard of aorto-bi-femoral bypass has durability unrivalled by other forms of peripheral revascularisation surgery. Furthermore, some have avoided endovascular interventions in this region because of fears of perforation, bleeding and limited technical success in an area where the blood vessels carry a heavy burden of disease and a large thrombotic load. Throughout surgical history we have seen advances in technology emerge to provide a medium through which the proceduralist may extend their indications for treatment. A number of re-entry devices which provide a reliable method of wire passage beyond chronic occlusions of the aorta and iliac arteries have emerged and for the first time are safely facilitating high technical success rates in the treatment of aorto-iliac occlusive disease (AIOD). What follows is a summary of both open and endovascular treatment options for AIOD. Moreover, this review will provide an evidence based description of the emerging litany of devices which aid in wire passage through this most challenging of vascular territories.
Department of Surgerym, Prince of Wales Hospital, Sydney, Australia. r.varcoe@unsw.edu.au
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Varcoe
D000714:Anastomosis, Surgical / Q000295:instrumentation; D001012:Aorta, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007925:Leriche Syndrome / Q000601:surgery*