Aorto-Iliac Disease: Update on Treatment Options and Data

During Monday morning’s focused symposium on Essentials of Endovascular Therapy, Dr. Frank Arko began his presentation on aorto-iliac disease by discussing the role of endovascular therapy in Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) II C and D inflow disease. He indicated that surgery is the preferred treatment of good-risk patients with type C lesions and is the treatment of choice for type D lesions. There has been a tremendous advancement in endovascular technique.

Dr. Arko reviewed some data available since the TASC II guidelines were published. Review articles and several studies have shown the feasibility of endovascular therapy for TASC II C and D lesions. Primary patency rate is lower for endovascular therapy compared with surgery (60% to 85%) at 5 years, and secondary patency rate is 80% to 98% at 5 years with endovascular therapy.

He then spoke about covered stents, which have a regular surface/mechanical barrier and more laminar flow. There is less chance for prolapse of plaque, less ingrowth of hyperplastic tissue; they are less thrombogenic and minimize intraoperative complications such as perforations and embolization.

Dr. Arko reviewed several trials looking at endovascular vs open repair and presented a case study of a 78-year-old woman with a preoperative diagnosis of chronic limb ischemia with rest pain and how she was treated.

In conclusion, Dr. Arko stated that endovascular techniques allow for the treatment of most aorto-iliac occlusive disease lesions from A-D, and most recent studies have demonstrated equivalent results between both groups.  However, the ENDO group appears to have slightly less disease, but dos appear to be a higher risk group. Good-risk patients with small vessels that included external iliac disease are patients that he tends to bias towards open surgery, and those patients with complete occlusion to the level of the renal arteries are patients that may be best served with open repair as first-line therapy.