Technical aspects of aortoiliac revascularization for chronic lower limb ischaemia

Atherosclerotic arterial disease affecting the leg is common and presents with a range of symptoms. Many patients with peripheral arterial disease, such as those with mild intermittent claudication, can be managed successfully without revascularization. As all techniques of revascularization carry a degree of risk to the patient and limb, it is essential to carefully identify patients who without revascularization, are at risk of limb loss or continued disabling symptoms. The technique chosen to revascularize a limb is largely dependent on the nature of the arterial lesion and the experience of the vascular team caring for the patient. For this reason, it is essential that careful consideration to the options for treatment are discussed in a multidisciplinary format. It is often suggested that an endovascular approach should be the first line of investigation, although the best evidence suggests that surgical bypass is better for patients whose life expectancy is greater. A range of revascularization techniques exist and this chapter examines the technical aspects of those in common use.