Treatment of the aorto-iliac segment in complex lower extremity arterial occlusive disease

Endovascular treatment of the aortoiliac segment in occlusive disease has an established role especially in TASC A and B lesions. Recent studies with modern stent technology have shown excellent results with one-year primary patency above 95%. Regarding different endovascular approaches, there is level Ib evidence supporting provisional stenting in stenosed arteries, and primary stenting in occlusion. While open surgery shows higher patency rates in direct comparison to endovascular techniques, the latter show significantly lower complication rates and lower mortality. The recommendations reserving TASC C and D lesions exclusively to surgery are currently challenged, especially in poor surgical candidates.