Annals of vascular surgery · 2026
Endovascular Management of Severe Aortoiliac Atherosclerotic Disease in the Setting of Acute Limb Ischemia: A Critical Review of the Literature.
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Vasquez Charles R, Loh Shang A
Аннотация
BACKGROUND: Severe acute limb ischemia in the setting of aortoiliac occlusive disease (AIOD) is a rare clinical syndrome that can lead to severe limb ischemia and often manifests in a bilateral fashion. Morbidity can be further magnified in patients who present with an embolic phenomenon in the setting of minimal pre-existing vascular disease. Treatment in this region can be technically complex due to the need to reconstruct the aortic bifurcation and the management of large amounts of thrombus with high potential for embolization. This critical review has 2 aims: (1) to describe our treatment algorithm and experience in treating this challenging problem; and (2) to synthesize the literature on existing techniques and devices available to treat acute aortoiliac thrombus, and separately, to review endovascular approaches that can be used to treat underlying aortoiliac occlusive disease.
METHODS: We performed a keyword search of the PubMed database, restricted to the last 20 years (2005-2025) to identify relevant peer-reviewed studies for inclusion in this manuscript. Review of references within the relevant papers (i.e., snowball sampling) was used to identify additional manuscripts. Both original studies as well as systematic reviews and meta-analyses were included.
RESULTS: When considering the management of AIOD with concomitant thrombosis, management strategies fall into 2 stages, with the first focusing on acute thrombus burden removal to uncover underlying lesions and to prevent embolization during treatment. The second stage of therapy involves correction of the underlying pathology that may be responsible for the acute occlusion.
CONCLUSION: With the significant advances in technology, endovascular solutions for both stages have slowly become the first-line and preferred treatment due to the reduced morbidity and excellent short- and mid-term results. In this critical review, we summarize the current endovascular techniques for both thrombus removal and the treatment of aortoiliac occlusive disease while also describing our approach to this challenging clinical problem.
METHODS: We performed a keyword search of the PubMed database, restricted to the last 20 years (2005-2025) to identify relevant peer-reviewed studies for inclusion in this manuscript. Review of references within the relevant papers (i.e., snowball sampling) was used to identify additional manuscripts. Both original studies as well as systematic reviews and meta-analyses were included.
RESULTS: When considering the management of AIOD with concomitant thrombosis, management strategies fall into 2 stages, with the first focusing on acute thrombus burden removal to uncover underlying lesions and to prevent embolization during treatment. The second stage of therapy involves correction of the underlying pathology that may be responsible for the acute occlusion.
CONCLUSION: With the significant advances in technology, endovascular solutions for both stages have slowly become the first-line and preferred treatment due to the reduced morbidity and excellent short- and mid-term results. In this critical review, we summarize the current endovascular techniques for both thrombus removal and the treatment of aortoiliac occlusive disease while also describing our approach to this challenging clinical problem.