Endovascular interventions for TASC II D femoropopliteal lesions

• Published in: Journal of vascular surgery Vol. 51; no. 6; pp. 1406 - 1412
• Main Authors: Baril, Donald T., MD, Chaer, Rabih A., MD, Rhee, Robert Y., MD, Makaroun, Michel S., MD, Marone, Luke K., MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2010; Elsevier
• Subjects: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - mortality; Ankle Brachial Index; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - mortality; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; Biological and medical sciences; Constriction, Pathologic; Diseases of the cardiovascular system; Female; Femoral Artery - diagnostic imaging; Femoral Artery - physiopathology; Humans; Limb Salvage; Male; Medical sciences; Middle Aged; Odds Ratio; Popliteal Artery - diagnostic imaging; Popliteal Artery - physiopathology; Proportional Hazards Models; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Time Factors; Treatment Outcome; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Wound Healing; Femoropopliteal; Cardiovascular disease; Endovascular route; Surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.01.062

Background Advances in endovascular techniques have provided new options in the treatment of complex infrainguinal occlusive lesions. The purpose of this study was to evaluate outcomes of endovascular interventions on TransAtlantic InterSociety (TASC) II D femoropopliteal occlusive disease. Methods All patients undergoing endovascular interventions for femoropopliteal occlusive disease between July 2004 and July 2009 were reviewed. Patient demographics, pre- and postprocedure ankle-brachial indices (ABI) and anatomic factors were analyzed. Outcomes evaluated included primary patency, assisted-patency, secondary patency, predictors of restenosis, and wound healing. Results Five hundred eighty-five limbs were treated during the period reviewed. The study group included 79 TASC D limbs in 74 patients (mean age 76.5 ± 11.9 years, male sex: 53%). Fifty-six limbs (71%) underwent treatment for critical limb ischemia, including 42 (53%) with tissue loss. Eleven patients (15%) had previous failed bypasses. Preoperative ABIs were unobtainable for 23 patients, while the remaining 56 had a mean baseline ABI of 0.54 ± 0.28. There was one periprocedural mortality. Five patients (6.3%) had periprocedural complications. Mean increase in ABI postprocedure was 0.49 ± 0.35. Follow-up was available for 74 limbs at a mean of 10.7 months (range, 1-35). There were 18 mortalities (24.3%) during the follow-up period. No patient required a major amputation during this follow-up period. Twenty-one limbs (26.6%) experienced restenosis and nine limbs (11.4%) experienced occlusion. Twenty-nine limbs underwent reintervention during the follow-up time, including nine which underwent multiple reinterventions. Primary, assisted-primary, and secondary patency rates at 12 and 24 months were 52.2%, 88.4%, 92.6% and 27.5%, 74.2%, and 88.9%, respectively. Predictors of restenosis/occlusion included hypercholesterolemia, the presence of a popliteal artery stent, and patients who were current or former smokers. Conclusions Endovascular interventions for TASC II D lesions can be safely performed with excellent hemodynamic improvement and limb salvage rates. Restenosis is not uncommon in this population, which mandates strict follow-up. Further follow-up is necessary to determine the long-term efficacy of these interventions.