Open management of complex infrarenal aortic occlusive disease

Open aortic reconstruction for complex aortoiliac occlusive disease is a time-honored and durable solution. Symptoms manifest as disabling claudication or chronic limb threatening ischemia in patients with multilevel disease. Advanced endovascular techniques have supplanted a large volume of aortic surgery. Nonetheless, it is essential for surgeons-in-training to learn and hone their skills in open aortic surgery. Comprehensive literature review over the past 50 years was conducted on the topics of "aortic occlusive disease," "aortic bypass," and "iliofemoral bypass." Pertinent articles were selected for inclusion as references. The technical aspects of the various aortoiliac exposures are described and selected case images were chosen from the senior author's experience. This review paper details the various operative approaches to open aortoiliac revascularization with emphasis on "tips and tricks" for the learner.