Chapter 36. Operative Management of Aortoiliac Occlusive Disease

• Significant chronic lower extremity ischemia.
  • Lifestyle-limiting claudication, tissue loss, and rest pain.
  • Risk factor modification partially helpful.
• Acute lower extremity ischemia.
  • Thrombosed aortoiliac system.
• Infected aortic graft (prior abdominal aortic graft for aneurysmal or occlusive disease).
• Abdominal aortic aneurysm with iliac disease (occlusive or aneurysmal).

Absolute

• Chronic ischemia: none.
• Acute ischemia: nonsurvivable acidosis.

Relative

• Cardiopulmonary comorbidities.
• Prior abdominal surgery.
• If significant comorbidities exist, extra-anatomic bypass (axillary-femoral bypass) is preferred.

• The patient should be supine and prepared from mid chest to the feet.
  • The abdomen is entered through a midline incision.
  • Groin incisions can be transverse but more often are longitudinal.

• Arterial line, central line, and pulmonary artery catheter for hemodynamic monitoring.
• Nothing by mouth.
• A nasogastric tube is needed for decompression for 12–24 hours in cases of abdominal entry.

• Respiratory failure.
• Renal failure.
• Myocardial infarction.