Midterm Outcomes After Infrapopliteal Interventions in Patients With Critical Limb Ischemia Based on the TASC II Classification of Below-the-Knee Arteries

Abstract

Purpose: To analyze the relationship between the new TransAtlantic Inter-Society Consensus (TASC II) infrapopliteal classification and limb outcomes among patients with critical limb ischemia (CLI). Methods: A single-center retrospective study was performed on 166 consecutive CLI patients (mean age 71 years; 113 men) undergoing endovascular treatment of 244 infrapopliteal lesions from 2006 to 2013. Patient, procedural, angiographic, and limb outcomes were compared for the new TASC A/B vs C/D classification for infrapopliteal lesions. Binary restenosis was determined by a peak systolic velocity ratio >2.0 by duplex ultrasound on follow-up at 1, 3, 6, and 12 months. Results: Seventy-two (43.4%) patients had TASC A/B lesions, while 94 (56.6%) had TASC C/D patterns of infrapopliteal disease. Baseline demographics and tissue loss (93% vs 94%, p=0.59) were similar between the groups. TASC A/B lesions were shorter (53±35 vs 170±83 mm, p<0.001), less severely stenosed (77%±24% vs 93%±14%, p<0.001), had a larger target vessel diameter (2.9±0.5 vs 2.6±0.5 mm, p<0.001), and were less frequently chronic total occlusions (24% vs 64%, p<0.001) compared with the TASC C/D group. Threeyear freedom from both amputation (85% vs 67%, p=0.02) and major adverse limb events (79% vs 61%, p=0.02) were significantly higher in the TASC A/B group. Technical success rates (95% vs 80%, p<0.001) and 1-year primary patency (58% vs 51%, p=0.04) were higher in the A/B group. Overall 3-year survival was similar between the groups (96% A/B vs 88% C/D, p=0.2). Conclusion: TASC C/D infrapopliteal lesions are associated with higher amputation and major adverse limb events rates and lower primary patency compared with TASC A/B infrapopliteal lesions. Further studies are needed to assess the association between TASC C/D infrapopliteal lesions and clinical outcomes in patients with CLI.

A Review of Distribution of Atherosclerosis in the Lower Limb Arteries of Patients With Diabetes Mellitus and Peripheral Vascular Disease

“…The pattern of vascular disease influences the options there are for revascularisation. Management of distal disease is more challenging than proximal disease, although advances in this area are being made [2][3][4][5] . Despite these advances patients with distal disease have a higher risk of an amputation and shorter amputation-free survival 6 .…”

Transpedal vs. femoral access for peripheral arterial interventions—A single center experience

“…The transpedal group had higher prevalence of CLI although the anatomical distribution of disease was significantly different between the two groups. Others have suggested similar findings where anatomic disease does not correlate with clinical severity …”

“…Although our study did not have very high complication rate in femoral group, this might be attributed to lower risk ambulatory patient population and exclusion of suprainguinal interventions.The transpedal group had higher prevalence of CLI although the anatomical distribution of disease was significantly different between the two groups. Others have suggested similar findings where anatomic disease does not correlate with clinical severity 20.…”

Management of Complications during Below-the-Knee Endovascular Treatment: A Technical Note

“…The first complication to develop is vascular spasm, which may occur after balloon angioplasty in stenotic or occluded vessels (1,(5)(6)(7). Moreover, spasms may be caused in the healthy blood vessels located in front of and behind the lesion during guidewire or balloon manipulation.…”