9
Table 7. Interventions for Aortoiliac Occlusive Disease
(AIOD) in Intermittent Claudication (cont'd)
Recommendations Grade
Level of
Evidence
EVT of AIOD in the presence of aneurysmal disease should
be undertaken cautiously. The SVS recommends that the
modality used should either achieve concomitant aneurysm
exclusion or should not jeopardize the conduct of any future
open or endovascular aneurysm repair.
1 C
In all patients undergoing revascularization for AIOD,
the SVS recommends assessing the common femoral
artery (CFA). If hemodynamically significant CFA
disease is present, the SVS recommends surgical therapy
(endarterectomy) as first-line treatment.
1 B
In patients with iliac artery disease and involvement of the
CFA, the SVS recommends hybrid procedures combining
femoral endarterectomy with iliac inflow correction.
1 8
The SVS recommends direct surgical reconstruction (bypass,
endarterectomy) in patients with reasonable surgical risk and
diffuse AIOD not amenable to an endovascular approach,
after one or more failed attempts at EVT, or in patients with
combined occlusive and aneurysmal disease.
1 B
In younger patients (age <50 years) with IC, the SVS
recommends a shared decision-making approach to engage
patients and inform them of the possibility of inferior
outcomes with either endovascular or surgical interventions.
2 C
The SVS recommends either axial imaging (eg,
computedtomography, magnetic resonance) or catheter-
based angiography for evaluation and planning of surgical
revascularization for AIOD.
1 U
When performing surgical bypass for aortoiliac disease,
concomitant aneurysmal disease of the aorta or iliac
arteries should be treated as appropriate (exclusion) and is a
contraindication to end-to-side proximal anastomoses.
1 U
For any bypass graft originating from the CFA, the donor
iliac artery must be free of hemodynamically significant
disease, or any pre-existing disease should be corrected
before performing the bypass graft.
1 U
