ACR Appropriateness Criteria® Management of Iliac Artery Occlusive Disease: 2024 Update

Management of iliac artery occlusive disease encompasses a review of peripheral arterial disease (PAD) diagnosis and treatment as a whole. There are several consensus documents that provide a comprehensive review of the topic. Differentiating optimal medical, surgical, and/or endovascular approaches to treat aortoiliac occlusive disease requires recognition of the likely etiology most responsible for the clinical symptomatology. Prompt diagnosis of acute limb ischemia versus chronic limb threatening ischemia is imperative to selecting the correct treatment pathway for individual patients. This document will attempt to summarize the data and most recent clinical trials to support clinical decision-making in the treatment of aortoiliac occlusive disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.