What are the SVS treatment guidelines for aortoiliac occlusive disease (AIOD)?

Updated: Sep 12, 2019
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Recommendations for interventions for aortoiliac occlusive disease (AIOD) in IC include the following:

  • EVT is preferred to open surgery for focal AIOD causing IC (grade 1 recommendation; evidence level B).
  • EVT is recommended as first-line revascularization therapy for most patients with common iliac artery or external iliac artery occlusive disease causing IC (grade 1 recommendation; evidence level B).
  • Selective use of bare-metal stents or covered stents for aortoiliac angioplasty is recommended for common iliac artery or external iliac artery occlusive disease, because of improved technical success and patency (grade 1 recommendation; evidence level B).
  • Covered stents are recommended for AIOD in the presence of severe calcification or aneurysmal changes where the risk of rupture may be increased after unprotected dilation (grade 1 recommendation; evidence level C).
  • For patients with diffuse AIOD undergoing revascularization, either EVT or surgical intervention is suggested as first-line therapy. Endovascular interventions that may impair the potential for subsequent aortofemoral bypass AFB in surgical candidates should be avoided (grade 2 recommendation; evidence level B).
  • EVT for AIOD in the presence of aneurysmal disease should be undertaken cautiously. The modality used either should achieve concomitant aneurysm exclusion or should not jeopardize the conduct of any future open or endovascular aneurysm repair (grade 1 recommendation; evidence level C).
  • In all patients undergoing revascularization for AIOD, the common femoral artery (CFA) should be assessed. If hemodynamically significant CFA disease is present, surgery (endarterectomy) is recommended as first-line treatment (grade 1 recommendation; evidence level B).
  • In patients with iliac artery disease and CFA involvement, hybrid procedures combining femoral endarterectomy with iliac inflow correction are recommended (grade 1 recommendation; evidence level B).
  • Direct surgical reconstruction (bypass, endarterectomy) is recommended in patients with reasonable surgical risk and diffuse AIOD not amenable to EVT, after one or more failed attempts at EVT, or in patients with combined occlusive and aneurysmal disease (grade 1 recommendation; evidence level B).
  • In younger patients (< 50 years) with IC, a shared decision-making approach is recommended to engage patients and inform them of the possibility of inferior outcomes with either EVT or surgery (grade 2 recommendation; evidence level C).
  • Either axial imaging (eg, CT or magnetic resonance imaging [MRI]) or catheter-based angiography is recommended for evaluation and planning of surgical revascularization for AIOD (grade 1 recommendation; evidence ungraded).
  • When surgical bypass is performed for AIOD, concomitant aneurysmal disease of the aorta or iliac arteries should be treated as appropriate (exclusion) and is a contraindication for end-to-side proximal anastomoses (grade 1 recommendation; evidence ungraded).
  • For any bypass graft originating from the CFA, the donor iliac artery must be free of hemodynamically significant disease or any preexisting disease should be corrected before the bypass procedure is performed (grade 1 recommendation; evidence ungraded).

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