Aortoiliac Interventions

This chapter provides a focused review on practical aspects of planning and performing endovascular treatment for aortoiliac peripheral artery disease (PAD). These include imaging, vascular access, balloons, stents, and covered stents for aortoiliac interventions, crossing and treatment of aortoiliac occlusive disease, hybrid intervention for iliofemoral occlusions, and managing aortoiliac intervention complications. Either one or more of the following modalities can accomplish imaging of aortoiliac arteries: conventional digital subtraction angiography (DSA), intravascular ultrasound (IVUS), computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and duplex ultrasonography (DUS). Covered endovascular reconstruction of the aortic bifurcation (CERAB) is a technique that uses an aortic cuff that covers the proximal edge of the covered stent in the distal aorta. This is done in an attempt to reconstruct a more anatomic aortic bifurcation. Access site complications are the most common and include groin hematoma, retroperitoneal bleeding, pseudoaneurysm, and arteriovenous fistula.