An 80-year-old female patient with a past medical history of hypertension, dyslipidemia, asthma, coronary artery disease status/post CABG presents with complaints of bilateral claudication in buttocks, hip and calf with left > right leg (Rutherford class I, category 3). Patient had ABI/PVR which showed 0.72 on the right and 0.44 on the left with waveforms suggestive of aortoiliac disease. Peripheral angiogram performed showed significant stenosis of the distal aorta, ostial right common iliac artery stenosis and chronic total occlusion (CTO) of the left common iliac with reconstitution at the proximal left external iliac (Image A). Borderline stenosis of the left superficial femoral artery and right posterior tibial artery were also noted. Patient currently planned for an endovascular intervention of the CTO of the left common iliac and distal aortic/common iliac bifurcation. We will discuss the endovascular indications, the approach towards complex iliac lesions and the TASC C/D lesions.
