0900_Cornwall.pdf

1、Aortoiliac Occlusive Disease:Algorithm,Devices and Techniques to Tackle the Complex CasesJames Cornwall,MD RPVIAssistant Professor SurgeryAssistant Professor RadiologyIcahn School of Medicine at Mount Sinai HospitalAlgorithm for treating AIOD Indications/Symptoms:Claudication,Rest pain,and tissue lo

2、ss Smoking cessation,management of diabetes,and antiplatelet,statin,and antihypertensive therapy.Imaging:CTA,MRA Classification:TASC-IITASC II:Trans-Atlantic Inter-Society Consensus Classification of Aortoiliac Lesions Guidelines suggest endovascular therapy is a first-line therapy for symptomatic p

3、atients with TASC II A and B lesions,whereas surgical therapy is usually considered for TASC II D lesions and for low-risk patients with TASC II C disease.Endovascular repair of AIOD is well established 1979 Grntzig and Kumpe reported a 2-year patency rate of 87%for treatment of iliac lesions with e

4、arly balloon angioplasty technique.1985 Tegtmeyer“kissing balloon”technique.1992 Palmaz and associates reported the results of a multicenter trial of 486 patients with iliac artery disease treated with balloon-expandable stents.1995 long-term results for treatment of iliac lesions with self-expandin

5、g stents were reported.2004 self-expanding stents in a multicenter prospective randomized trial,with similar 1-year primary patency of greater than 90%.In a recent systematic review of 19 nonrandomized cohort studies,4-year primary patency for Trans-Atlantic Inter-Society Consensus(TASC II)classes C

6、 and D aortoiliac lesions ranged from 69%to 88%Algorithm:Access Access site suitability If significant CFA disease,consider simultaneous or staged femoral endarterectomy Ipsilateral and contra-lateral access For CIA disease,prefer to treat ipsilateral For EIA disease,prefer to treat contralateral up