Editing Aortoiliac occlusive disease (section)

== Treatment ==

=== Indications for intervention ===

* Disabling intermittent claudication that significantly affects a patient's daily lifestyle despite optimal medical therapy
* Ischaemic rest pain
* Tissue loss

=== Medical interventions: ===

* Smoking cessation
* Weight loss
* Antiplatelets
* Treat:
** HTN
** Hyperlipidaemia
** Diabetes
* Trial of organised exercise program

=== Endovascular vs open: ===

* Type A and B: endovascular offered first
* Type D: open revasculararisation, unless precluded by comorbidity
* Type C: probably also endovascular first now


=== Surgical revascularisation ===

* Aortobifemoral bypass grafting is now the preferred open approach for patients with advanced disease but acceptable operative risk
** Dacron graft tunneled directly on top of existing vessels down to CFA
**
* Femorofemoral bypass
** Dependent on a nice patent contralateral inflow vessel
** Graft is tunneled across superfiscial to the pubis from one side to the other
* Axillobifemoral bypass
** Used in ill, older patients with infrarenal aortic or iliac occlusive disease resulting in critical limb ischaemia
* Results are excellent, with 10 year AFB graft patency of 85%. Younger patients do worse, unknown why. Extra-anatomic graft results are slightly worse but still acceptable.

=== Endovascular ===

=== Pre-op optimisation ===

* Evaluate cardiac, pulmonary, renal, cerebrovascular and haematologic disease
* Assume CAD
* In CKD, delay until after contrast load has been excreted from angiogram
* Periop beta blockade and continuation of aspirin


[[Category:Vascular]]