CLI (Rutherford class IV-VI) is a terminal stage of peripheral artery disease (PAD); it is defined by the presence of resting pain and/or tissue loss for at least two weeks that may require urgent revascularization to promote healing and prevent limb loss.For patients with infrarenal aortoiliac occlusive disease, the revascularization options are surgery like aortofemoral bypass and axillofemoral bypass or percutaneous intervention. Aortoiliac and aortofemoral bypass procedures are associated with 74% to 95% 5-year patency rates, respectively, which are comparable but not superior to percutaneous therapies.These operations may imply a significant morbidity and mortality on CLI patients who usually have multiple comorbid conditions and are considered high risk patients.

Conflict(s) of Interest


References with DOI

1. Slovut DP, Sullivan TM. Critical limb ischemia: medical and surgical management. Vasc Med. 2008;13(3):281-91. https://doi.org/10.1177/1358863x08091485

2. White CJ, Gray WA. Endovascular therapies for peripheral arterial disease: an evidence-based review. Circulation. 2007;116(19):2203-15. https://doi.org/10.1161/circulationaha.106.621391

3. Murphy TP, Ariaratnam NS, Carney WI, Jr., Marcaccio EJ, Slaiby JM, Soares GM, et al. Aortoiliac insufficiency: long-term experience with stent placement for treatment. Radiology. 2004;231(1):243-9. https://doi.org/10.1148/radiol.2311030408

4. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75. https://doi.org/10.1016/j.ejvs.2006.09.024

5. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, et al. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010;51(5 Suppl):5S-17S. ttps://doi.org/10.1016/j.jvs.2010.01.073

6. Clair DG, Beach JM. Strategies for managing aortoiliac occlusions: access, treatment and outcomes. Expert Rev Cardiovasc Ther. 2015;13(5):551-63. https://doi.org/10.1586/14779072.2015.1036741

7. Kim TH, Ko YG, Kim U, Kim JS, Choi D, Hong MK, et al. Outcomes of endovascular treatment of chronic total occlusion of the infrarenal aorta. J Vasc Surg. 2011;53(6):1542-9. https://doi.org/10.1016/j.jvs.2011.02.015

8. Bosch JL, Hunink MG. Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology. 1997;204(1):87-96. https://doi.org/10.1148/radiology.204.1.9205227

9. Pedersen OM, Aslaksen A, Vik-Mo H. Ultrasound measurement of the luminal diameter of the abdominal aorta and iliac arteries in patients without vascular disease. J Vasc Surg. 1993;17(3):596- 601. https://doi.org/10.1016/0741-5214(93)90161-e

10. Klonaris C, Katsargyris A, Tsekouras N, Alexandrou A, Giannopoulos A, Bastounis E. Primary stenting for aortic lesions: from single stenoses to total aortoiliac occlusions. J Vasc Surg. 2008;47(2):310-7. https://doi.org/10.1016/j.jvs.2007.10.016