Iliac artery revascularization: overview of current interventional therapies

The treatment of patients with peripheral arterial disease has evolved tremendously since the early 1960s, when Charles Dotter first successfully revascularized a superficial femoral artery occlusion in a patient with critical limb ischemia. Endovascular interventions have become the preferred therapy, as studies show equivalent, if not superior, procedural success and clinical outcomes compared with open-surgical options. Numerous devices have been developed over the last several decades, from percutaneous transluminal angioplasty to stenting with bare-metal and covered stents. Many of the stents used in vascular therapies were developed for use in the biliary system. Off-label use in the iliac and infrainguinal arteries is a regular practice, but well-designed clinical trials are needed to verify safety and effectiveness of these devices in various vascular beds. Several trials have been carried out, and are reviewed in this article, evaluating balloon-expandable, self-expandable and covered stents in the treatment of iliac occlusive disease.