[Surgical treatment of aorto-iliac occlusive disease]

Recently, various endovascular techniques were applied to the short segmental stenosis of aorto-iliac artery. However, bypass operation is the most reliable treatment for multiple stenotic or occlusive lesion. Preoperative systemic evaluation is important for the adequate selection of the patients and the operations. Dipyridamole-thallium scintigraphy is more useful than exercise stress testing to assess cardiac risks of patients with peripheral arterial diseases. Anatomical bypass is the standard operation resulting in favorable patency. Despite of relatively inferior long term patency, extra-anatomical bypass operations are useful alternatives for the patients having high systemic risks or severe sclerosis of aorto-iliac arteries. The improved medical care of the elderly patients with severe systemic diseases results in the increase of extra-anatomical bypass and extended operation combined with infrainguinal revascularization.