Aortoiliac: Covered, Uncovered, CERAB as It Relates to Peripheral Arterial Disease.

Abstract

Peripheral arterial disease (PAD) affects over 200 million worldwide and is the leading cause of major limb amputation, with individuals suffering from PAD being at three times greater risk of dying compared with matched controls. TASC-II guidelines provide a consensus on the management of PAD based on the collaboration between international vascular specialties. These guidelines previously outlined open surgery as the gold standard for treatment of aortoiliac disease and PAD as it has demonstrated consistent long-term results. However, this approach is also associated with high perioperative mortality, especially when compared with endovascular techniques. With recent developments in endovascular technology, user technique, and experience, this approach has become more widely used as primary intervention for aortoiliac disease. One of these novel techniques includes covered endovascular reconstruction of the aortic bifurcation, which has demonstrated excellent technical success and improved primary and secondary patency rates with follow-up. The aim of this review is to compare the efficacy of these approaches to the treatment of aortoiliac disease and demonstrate the benefits of the shift toward an endovascular-first approach to treatment of this disease, regardless of lesion complexity or severity.