The management of severe aortoiliac occlusive disease: Endovascular therapy rivals open reconstruction

A, Transbrachial aortography documents an aortic occlusion in a 68-year old woman with rest pain. Late images document the presence of distal iliac arteries reconstituted via collaterals (not shown) B, Femoral access is obtained with ultrasound guidance and endovascular recanalization is performed using a hydrophilic guidewire and catheter. Primary stenting using self-expanding nitinol stents with postdeployment balloon angioplasty restores normal pulsatile perfusion to both lower extremities. Bottom panels, Inaudible Doppler signals preoperatively to ankle-brachial indices of 1.0 bilaterally, transmetatarsal and digital waveforms are shown.

Distribution of patients undergoing aortobifemoral (ABF; striped bars) bypass and recanalization, percutaneous transluminal angioplasty, and stenting (R/PTAS, dotted bars) classified by TransAtlantic InterSociety Concensus (TASC) criteria. Both groups had similar distribution of extensive aortoiliac occlusive disease treated by either open (ABFB) or endovascular (R/PTAS) techniques.

A, Kaplan-Meier curve estimates for (A) primary patency, (B) secondary patency, and (C) limb salvage in patients undergoing aortobifemoral (ABF; solid line) bypass vs recanalization, percutaneous transluminal angioplasty, and stenting (R/PTAS, dashed line) over 36 months (standard error <10%). A, Primary patency for ABF bypass was 93%, which was significantly higher than 74% for patients undergoing R/PTAS (P = .002). B, Secondary patency was 97% for patients undergoing ABF bypass vs 95% for R/PTAS. No significant difference was found between groups (P = .3). C, Limb salvage rates were 98% for both groups (P = .97).

Survival for patients undergoing aortobifemoral (ABF; solid line) bypass vs recanalization, percutaneous transluminal angioplasty, and stenting (R/PTAS, dashed line) was equivalent at 36 months (80%) by Kaplan-Meier analyses. Standard error <10%.