title: Strategies for managing aortoiliac occlusions: access, treatment and outcomes.
abstract: Treatment of severe aortoiliac disease has dramatically evolved from a dependence on open aortobifemoral grafting to hybrid and endovascular only approaches. Open surgery has been the gold standard treatment of severe aortoiliac disease with excellent patency rates, but with increased length of stay and major complications. In contrast, endovascular interventions can successfully treat almost any lesion with decreased risk, compared to open surgery. Although primary patency rates remain inferior, secondary endovascular interventions are often minor procedures resulting in comparable long-term outcomes. The risks of renal insufficiency, embolization and access complications are not insignificant; however, most can be prevented or managed without significant clinical consequence. Endovascular therapies should be considered a first-line treatment option for all patients with aortoiliac disease, especially those with high-risk cardiovascular comorbidities.
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Beach
mesh_terms: D001018:Aortic Diseases / Q000503:physiopathology / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: access; aortic occlusion; aortoiliac occlusion; atherosclerosis; endovascular; iliac occlusion; iliac stenosis; stent