PhD defence J.A. (Joost) Bekken

Summary:

Peripheral artery disease (PAD) is caused by atherosclerotic stenoses or occlusions of the lower limb and leads to intermittent claudication and chronic limb threatening ischemia (CLTI). When PAD is located in the aortoiliac segments, it is termed AIOD (Aortoiliac Occlusive Disease). All patients with PAD should receive intensive risk factor modification, both through life style modification and medical therapy. For patients with claudication, supervised exercise therapy (SET) is the first treatment step. When disabling symptoms persist after SET, and for patients with CLTI, revascularization is warranted. When considering revascularization there are, generally speaking, two options: Surgical or endovascular. In general, surgical repair has higher patency rates, but comes with higher morbidity, mortality and longer hospital stay. Endovascular repair has lower patency rates and, in the past, was considered unsuitable for more advanced lesions. Nowadays, indications have broadened and most physicians advocate an ‘endovascular first’ strategy for all lesions, but patency rates are still lower than for surgical repair. For some indications, hybrid procedures are available, combining some of the benefits of both open and endovascular procedures. In this thesis several endovascular and hybrid techniques and strategies for treating iliac artery disease have been studied.