Treatment of Aortoiliac Occlusive Disease: Medical versus Endovascular versus Surgical Therapy.

OPINION STATEMENT: Aortoiliac occlusive disease (AIOD) is an insidious, progressive atherosclerotic process that can lead to claudication, rest pain, tissue loss, and eventual lower extremity amputation. The patient with AIOD is also at risk for both fatal and nonfatal cardiovascular events. Treatment of the disease includes both risk factor modification and efforts to improve blood flow to the lower extremity. For mild to moderate intermittent claudication, medical therapy as well as a supervised exercise program is advised. For debilitating claudication or critical limb ischemia, a number of recent studies support an endovascular approach for patients with AIOD, citing patency rates that compare favorably to open surgery. Surgical revascularization, however, should still be considered in selected patients.