Aortoiliac Occlusive Disease: Surgical Versus Interventional Therapy

The treatment of atherosclerotic aortoiliac disease has evolved from surgical endarterectomy to aortobifemoral bypass grafting to endovascular balloon angioplasty with stenting. Excellent results can be realized with each of these techniques in appropriately selected patients. Stenting has broadened the applicability of endovascular treatment to patients with iliac occlusions and those in need of concomitant infrainguinal bypass. Improvements in surgical care have reduced the risk associated with open revascularization. Percutaneous endovascular therapy is typically advocated as the initial treatment option, reserving bypass surgery for treatment failures--patients with severe ischemia or patients with extensive disease, particularly with lesions that extend into the common femoral artery.