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Aortoiliac occlusive disease - a novel classification system based on anatomical segments and disease severity for
Ngozi Lola Ogunsanya1, Ross Milner1, Chris L Delaney1
1College of Medicine and Public Health, Flinders Medical Centre and Flinders University Department of Vascular Surgery, Bedford Park, AU-SA, Australia.
Insights
A new classification system simplifies categorizing aortoiliac occlusive disease severity by anatomical segment. This tool aids vascular surgeons in planning treatment strategies for peripheral artery disease.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Disease Classification
Background:
- Management of aortoiliac occlusive disease (AIOD) has advanced, necessitating refined tools for treatment planning.
- Existing classification systems like TASC II guide treatment but may not fully address anatomical specifics.
- Accurate identification of affected arterial segments is crucial for effective AIOD management.
Purpose of the Study:
- To introduce a simple classification system for AIOD severity by anatomical segment.
- To provide vascular surgeons with a tool to guide decision-making and management strategies.
- To include common femoral artery disease as a distal extent relevant to intervention access.
Main Methods:
- A classification system using segment letters and numbers for treatment planning.
- Disease severity categorization based on angiography, CTA, and MRA.
- Exemplification of the system's clinical application through two case studies.
Main Results:
- A user-friendly classification system for AIOD has been developed.
- The system effectively categorizes disease by anatomical segment and severity.
- Clinical cases demonstrate the practical application and ease of use.
Conclusions:
- This novel classification system offers an intuitive framework for AIOD management.
- It provides specific anatomical and severity information to support clinical decisions.
- The system serves as a complementary tool to existing classifications for vascular surgery armamentarium.
Aims:
The aim of this classification system is to provide vascular surgeons with a simple tool that categorises disease severity by anatomical segment in aortoiliac occlusive disease and thus guide decision making and management strategies. Disease of the common femoral arteries is included as the distal extent of disease with respect to access for both open and endovascular intervention is essential to management planning.
Methods:
The classification system designates diseased segment letters and numbers to guide treatment planning. The degree of disease other than stenotic or occluded is not required. In a similar manner to the TNM classification, anatomy and disease severity - based on angiography, CTA, and MRA - are categorised using a simple, user-friendly method. Two clinical cases are presented to exemplify the clinical application of this classification system.
Results:
A simple and useful classification system is presented and ease of use exemplified by two clinical cases.
Conclusions:
Management strategies for peripheral artery disease in general, aortoiliac occlusive disease specifically, have evolved rapidly in recent years. Existing classification systems, such as TASC II, steer the clinician towards specific treatment approaches. However, the first step in the management decision-making process is the accurate identification of the arterial segments that require treatment. None of the existing classification systems specifically address anatomy as an entity in itself. This classification system provides an intuitive framework, based on letters and numbers, that provides specific information on arterial segments and disease severity in aortoiliac occlusive disease on which clinicians can base management decisions. It has been developed to bolster this aspect of the vascular surgery armamentarium; to be used as a decision making and management planning tool, in partnership with, not instead of, existing classification systems.
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