0915_Genovese.pdf

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1、How I Treat Distal Aorto-Iliac Occlusive DiseaseLiz Genovese,MD,MS,FACSAssistant Professor of SurgeryPenn Advanced Limb Preservation Program-Director at HUPDivision of Vascular Surgery and Endovascular TherapyUniversity of PennsylvaniaNY Endovascular Summitt 20252DisclosuresConsultant and Educator:A

2、bbott,Boston Scientific,Cook,Gore,Inari,Penumbra,R3,ShockwaveAdvisory Board:Boston Scientific,Cook,PhilipsResearch Support:Boston Scientific3Aortoiliac Occlusive Disease(AIOD)Treatment of AIOD for claudication or CLTI has excellent durabilityTreatment depends on the extent of disease and surgical ri

3、sk of the patient Surgery-Aortobifemoral BypassGold standard for TASC C&D lesions80%and 75%5-yr and 10-yr patency rates,respectively However,endovascular therapy is safe and durable and is now considered first-line treatmentNorgren J Vasc Surg 2007;2016 AHA/ACC Guidelines JACC 2017Reed AB,et al.The

4、impact of patient age and aortic size on the results of aortobifemoral bypass grafting.J Vasc Surg.20034Recent Guidelines:Endovascular Is 1stLine Therapy for Most AIOD2016 AHA/ACC Guidelines JACC 2017;ESVS 2024 Clinical Guidelienes“Endovascular procedures are effective as a revascularization option

5、for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac occlusive disease”Class 1,Level A Recommendation“For patients of Low Risk,open surgery may be considered for TASC C/D with lesions that include iliac arteries as well as the aorta up to the renal arteries du

6、e to favorable patency rates”Class IIb,Level B Recommendation5Conte J Vasc Surg 201962020 SCAI Guidelines for AIOD Interventions7Preoperative Planning is Critical:CTA with run offAnatomy:AortaIliac arteriesCommon femoral arteriesCalcification and lesion morphologyVessel diametersRVDAneurysmal degene