Unilateral iliac artery total occlusion

A 67-year-old woman with extensive cardiovascular history presented with severe, lifestyle-limiting claudication progressing to rest pain (Rutherford III–IV).

Imaging revealed a total occlusion of the left common iliac artery, with distal refilling through collateral pathways with a patent hypogastric artery.

In such a patient with multiple comorbidities and complex anatomy, what is the most appropriate revascularisation strategy?

Gustavo A. Basso

Leforte Hospital – São Paulo, Brazil

Part I - Case presentation

A 67 year-old-woman, BMT + 🚭 🚬
💊 anti-hypertensive, statin, aspirin
Symptomatic claudication over very short distances / pain at rest – Rutherford III/IV
2 coronary stents, hemorrhagic stroke, cerebral aneurysm clipping (without sequelae)
Cardiac status: grade I LV diastolic dysfunction. Aortic valve with incipient fibrocalcific degeneration.
Normal spirometry, with no variation after bronchodilator administration (salbutamol spray 400 mcg)

MRI: severe atheromatosis in all arterial segments with total occlusion of the left common iliac artery. Refilling of the external iliac artery by collateral and patent hypogastric artery.

Statement of Financial Interest

Dr. Gustavo Aurelio Basso declares that he has no relevant financial relationships or conflicts of interest to disclose.