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Context The progress and innovations in endovascular tools have replaced standard surgical intervention with endovascular intervention, including long, complex lesions. Aim The aim of the study was to evaluate the results of endovascular management as the first-approach intervention for symptomatic extensive Trans-Atlantic Inter- Society Consensus (TASC) C and D aortoiliac disease. Patients and methods This was a prospective study. Fifty patients with long, complex TASC C and D aortoiliac lesions underwent revascularization by endovascular-first approach. Technical success and follow-up results after 6, 12, and 24 months were documented. SPSS software version 18 was used for statistical analyses. Results Of the 50 patients, 84% were male. All the patients had TASC C and D lesions and 66% of them had critical limb ischemia. All the patients were treated by endovascular-first approach. A total of 92 stents were used, of which 66.3% were balloon mounted, and they were located in the common iliac artery. The technical success rate was 90%, and the ankle-brachial (A/B) index improved significantly (P=0.0001). The primary patency rates were 100, 81.8, and 80% at 6, 12, and 24 months, respectively. A total of 6.6% of patients developed major complications, which were successfully managed. Mortality rate was 2.2%, which was not procedure related. Conclusion The endovascular-first approach could be a good alternative and replace the standard surgical management for long, complex aortoiliac occlusive disease. [ABSTRACT FROM AUTHOR]

Internal thoracic artery (ITA) is an excellent conduit for coronary artery bypass surgery (CABG). We present a patient with known preoperative aortoiliac disease with anterior collateral pathway who had an indication for elective coronary bypass. The use of ITA in these patients may cause lower limb ischemia. Detecting Winslow's anastomotic pathway before CABG is of utmost importance. [ABSTRACT FROM AUTHOR]