Interventions for Aorto-Iliac Disease

Aorto-iliac stenoses or occlusions are common in people who present with symptomatic peripheral artery disease (PAD). The gold standard in treating steno-occlusive aorto-iliac disease has been open surgical reconstruction, which has proven efficacy and long-term patency. Endovascular advances have allowed minimally invasive reconstructions in this population. More complex anatomies are now treated with endovascular devices, which offer the opportunity to revascularise limbs with less blood loss and less immediate impact on the patient’s physiology. Both open surgery and endovascular treatment in patients with occlusive aorto-iliac disease can be associated with significant complications. This is due to the complex technical nature of any revascularisation procedure when someone has severe occlusive arterial disease and the patients’ co-morbidities, who are often frail when presenting for revascularisation. In this chapter we cover the relevant literature and toolkit regarding endovascular aorto-iliac reconstruction, especially in more challenging anatomies.