What are the ESC/ESVS guidelines for revascularization of aortoiliac occlusive lesions in patients with intermittent claudication (IC)?

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

Recommendations for revascularization of aortoiliac occlusive lesions in patients with intermittent claudication and severe chronic limb ischemia are as follows:

  • Endovascular-first strategy is recommended for short (< 5 cm) occlusive lesions (class I recommendation; evidence level C)
  • In patients fit for surgery, aorto(bi)femoral bypass should be considered (class IIa recommendation; evidence level B)
  • Endovascular-first strategy should be considered in long and/or bilateral lesions in patients with severe comorbidities (class IIa recommendation; evidence level B)
  • Endovascular-first strategy may be considered for aortoiliac occlusive lesions if it is done by an experienced team and does not compromise subsequent surgical options (class IIb recommendation; evidence level B)
  • Primary stent implantation rather than provisional stenting should be considered (class IIa recommendation; evidence level B)
  • Open surgery should be considered in fit patients with an aortic occlusion extending up to the renal arteries (class IIa recommendation; evidence level C)
  • For iliofemoral occlusive lesions, a hybrid procedure combining iliac stenting and femoral endarterectomy or bypass should be considered (class IIa recommendation; evidence level C)
  • Extra-anatomic bypass may be indicated for patients with no other alternatives (class IIb recommendation; evidence level C)

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