Outcome of Endovascular Versus Open Surgical Interventions for Isolated Aorto-Iliac Occlusive Disease

Introduction: Revascularization is the treatment of choice for lifestyle-limiting claudication or critical limb ischemiain aortoiliac occlusive disease (AIOD). Aortobifemoral bypass (ABFB) remains the gold standard for severe cases.However, advances in endovascular techniques have demonstrated favorable outcomes, particularly in high-risksurgical patients.Aim of work: This study aimed to compare the clinical outcomes, primary patency rates, complication profiles,and limb salvage of open surgical ABFB versus EVT by iliac stenting in patients with moderate to severe isolatedAIOD (TASC II C and D lesions).Patients and methods: This study retrospectively reviewed prospectively collected data of patients with TASC Cand D isolated AIOD treated between January 2023 and June 2024 at Egypt Healthcare Authority and Suez CanalUniversity Hospitals. Patients underwent either ABFB or endovascular therapy (EVT) via iliac stenting. Demographic,procedural, and follow-up data were analyzed.Results: A total of 28 patients were included: 11 underwent ABFB and 17 underwent EVT. Technical success was100% in both groups. The mean follow-up was 11.9 ± 2.3 months (12.5 ± 2.4 for ABFB, 11.5 ± 2.3 for EVT). Limbsalvage was achieved in all cases, with no major amputations. The 12-month primary patency rate was 100% inthe ABFB group versus 85% in the EVT group (p = 0.2).Conclusion: Both open surgery and endovascular therapy are effective for treating complex AIOD. While ABFBoffers superior patency, EVT is a safe, less invasive alternative with acceptable outcomes in appropriately selectedpatients.