Outcomes of endovascular treatment for patients with TASC II D femoropopliteal occlusive disease: a single center study

Abstract

BackgroundAdvances in endovascular technology led to an alternative treatment option for TASC II D (TransAtlantic Inter-Society Consensus II class D) lesions. This study was aimed to evaluate the outcomes of endovascular treatment for TASC II D femoropopliteal lesions.MethodsEndovascular intervention with bare nitinol stent implantation was performed on 58 limbs (53 patients) with TASC II D femoropopliteal lesions from January 2011 to March 2013. Kaplan-Meier curves of primary patency, assisted patency and second patency were performed. Predictive factors of re-stenosis/occlusion were evaluated by univariate methods.ResultsTotal 53 patients with mean age of 74.2 ± 8.2 (range, 58.0–91.0 years) and mean lesion length of 314.8 ± 64.3 mm (188.2–400.4 mm) were enrolled. The mean follow-up time was 12.2 ± 6.1 months (5–38 months). Revascularization was successfully on 95 % lesions by bare nitinol stent implantation. Primary patency rates at 1, 2 and 3 years were 63 %, 12 % and 12 %, respectively. Assisted primary patency rates at 1, 2 and 3 years were 77 %, 31 % and 31 %, respectively. Secondary patency rates at 1, 2 and 3 years were 96 %, 63 % and 63 %. During one-year follow-up, no major amputation was occurred. Univariate analysis revealed that number of run-off vessels was a potential predictor of re-stenosis/occlusion.ConclusionEndovascular treatment of TASC II D femoropopliteal artery occlusion has a high technical success rate with acceptable one-year patency rate. The long-term outcomes are poor, but endovascular intervention could be a good alternative for patients unsuitable for surgical bypass.

Endovascular Repair of Peripheral Arterial Disease

“…Although endovascular approach in the aortoiliac segments results in excellent acute and acceptable long-term patency, procedures in the femoropopliteal and particularly in the infrapopliteal segments are still hampered by high rates of restenosis, which is the major drawback of this technique and still an unmet challenge. 12 Antiproliferative drug-eluting devices have been shown to reduce the rate of restenosis in the femoropopliteal segments; their beneficiary effect for treatment of lesions below the knee, however, has not been demonstrated yet. We also prefer drugcovered/coated balloons for distal lesions resistant to initial PTA.…”

The Evaluation of the Success Rate, Complications and Mid-Term Follow Up Results of Patients with Peripheral Arterial Disease of Lower Limb Treated Using Endovascular Therapy : A Single Center Study

“…Korkmaz et al reported a primary patency rate of 84% and freedom from re-intervention for 8 years at a 76% rate in a similar singlecenter study (8). Another study done by Guo et al showed a successful revascularization rate of 95% and a 77% firstyear primary patency rate for the TASC II D lesions (7,9). These results together seem promising and a prediction of the shift from open surgery to newer endovascular techniques doesn't seem unreasonable.…”

“…Our study had some limitations with the length of followup period being the most important one. Data from other similar papers suggest that risk of re-occlusion and the need for re-intervention increases with time therefore studies with long-term follow-ups can show the patency rate more accurately (8,9,11). Another limitation was the study being carried out in a single center without the diversity of equipment and expertise therefore not representing a bigger population.…”

A Comparison of Outcomes After Lower Extremity Bypass and Repeat Endovascular Intervention Following Failed Previous Endovascular Intervention for Critical Limb Ischemia

“…However, recent updates to the guidelines (TASC II) concur with our conclusion that when anatomy is suitable or the patient is a poor operative candidate, endovascular intervention should be attempted prior to open bypass. [17][18][19] This study supplements the data available to guide decisionmaking regarding repeat revascularization after previous failed endovascular therapy. Current literature gives conflicting views on best approach after failed endovascular intervention.…”

“…However, recent updates to the guidelines (TASC II) concur with our conclusion that when anatomy is suitable or the patient is a poor operative candidate, endovascular intervention should be attempted prior to open bypass. 17 -19…”