Endovascular treatment of iliac artery chronic total occlusions

Approximately 8.5 million American adults are affected by peripheral artery disease (PAD). The iliac arteries and infrarenal aorta are among the arterial circulations most commonly affected by atherosclerotic chronic total occlusion (CTO) and constitute approximately one third of cases of PAD. Percutaneous angioplasty for iliac CTO was first described by Tegtmeyer et al. in 1979 in a 55-year-old diabetic woman with nonhealing foot ulcers in association with a CTO of the right common iliac artery (CIA) [1]. While surgical bypass can be performed with high long-term patency for aortoiliac PAD, endovascular interventions are increasingly being used to treat disabling claudication in such patients [2]. Surgical bypass options vary based on the specific anatomy, but include aortofemoral or aorta bi-femoral bypass, iliofemoral bypass, femoral-femoral bypass, and aortoiliac endarterectomy. Surgical bypass is associated with satisfactory improvement in symptoms and long-term patency rates, but such operations may incur significant operative morbidity and mortality. Thus endovascular aortoiliac interventions are often considered as a first-line treatment strategy for symptomatic patients with aortoiliac disease [2, 3].