From the Guidelines
Management of poor inflow and outflow of the iliac artery should prioritize endovascular interventions, including balloon angioplasty with or without stenting, as the first-line treatment for symptomatic patients with significant stenosis or occlusion. This approach is supported by the most recent and highest quality study, which recommends endovascular therapy as the primary treatment for iliac artery occlusive disease 1.
Key Considerations
- Initial management involves medical optimization with antiplatelet therapy (aspirin 81-325 mg daily), statins (atorvastatin 40-80 mg or rosuvastatin 20-40 mg daily), and risk factor modification including smoking cessation, diabetes control, and hypertension management.
- For acute iliac artery ischemia, prompt restoration of distal blood flow is crucial, and treatment options include catheter-directed thrombolysis, mechanical thrombectomy, and surgical embolectomy 1.
- The choice between endovascular and surgical approaches depends on lesion characteristics, patient comorbidities, and surgical risk, with endovascular approaches preferred for focal disease and surgery often reserved for extensive disease or failed endovascular interventions 1.
Treatment Options
- Endovascular interventions: balloon angioplasty with or without stenting, catheter-directed thrombolysis, and mechanical thrombectomy.
- Surgical options: endarterectomy, bypass procedures (aortofemoral, iliofemoral, or femorofemoral bypass), and hybrid procedures combining endovascular and open techniques.
- Medical management: antiplatelet therapy, statins, and risk factor modification.
Post-Intervention Care
- Lifelong antiplatelet therapy.
- Regular follow-up with duplex ultrasound surveillance at 1,6, and 12 months, then annually.
- Monitoring for signs of restenosis or recurrent ischemia, and prompt intervention if necessary 1.
From the Research
Management of Poor Inflow and Outflow of the Iliac Artery
Poor inflow and outflow of the iliac artery can be managed through various endovascular and surgical techniques. The choice of treatment depends on the underlying cause of the flow limitation, patient characteristics, and the severity of the disease.
Diagnostic Evaluation
- Imaging techniques, such as angiography, play a crucial role in the diagnosis and assessment of iliac artery disease 2.
- Knowledge of the underlying lesion and its location is essential for effective treatment planning.
Endovascular Treatment
- Endovascular therapy is the treatment of choice for type A and the preferred treatment for type B lesions, and can be applied in type C and even type D lesions in selective patients 3.
- Percutaneous transluminal angioplasty (PTA) and stenting are commonly used endovascular techniques for managing iliac artery occlusive disease.
- Stent placement can improve hemodynamic and clinical results, and may be a valuable adjunct in the management of iliac artery disease 4.
- Internal iliac artery angioplasty and stenting is a technically feasible and safe procedure that can provide symptomatic relief in patients with localized thigh and buttock claudication 5.
Technical Considerations
- Difficult iliac artery access can be a limiting factor in endovascular management, and requires careful preoperative planning and alternative access strategies 6.
- The choice of stent type depends on lesion morphology and location, but there is insufficient evidence to support the use of a particular stent design 3.