Outcomes of endovascular interventions for TASC II B and C femoropopliteal lesions

Abstract

Endovascular interventions for TASC II B and C lesions are associated with restenosis/occlusion rates that are at least as good as those of open femoropopliteal bypass surgery from historical, previously published series. Furthermore, overall assisted-patency rates are excellent, although low preoperative ABIs continue to be associated with worse outcomes.

Are flow-mediated vasodilatation and intima-media thickness of the brachial artery associated with restenosis after endovascular treatment of peripheral arterial occlusive disease?

“…This correlation has already been shown by Baril et al [34]. Further studies are needed to evaluate whether primary stent implantation in longer stenoses might be favourable.…”

Endovascular interventions for TASC II D femoropopliteal lesions

“…Previous studies have demonstrated worse outcomes with more advanced TASC classification, and TASC D classification, alone has been shown to be a predictor of restenosis. 5,6,14,15 Although not directly comparable given the retrospective nature of the two studies, our previously reported data on TASC B and C femoropopliteal lesions demonstrated assisted-primary patency rates of 89.3% at 12 months and 87.1% at 24 months and secondary patency rates of 94.0% at 12 months and 94.0% at 24 months. Comparatively, for the TASC D limbs in this series, the assisted-primary and secondary patency rates were 88.4% at 12 months and 74.2% at 24 months and 92.6% at 12 months and 88.9% at 24 months, respectively.…”

“…We have previously demonstrated hypercholesterolemia to be a predictor of restenosis in TASC B and C lesions, but the exact mechanism remains ill-defined. 6 Given the significant contribution of tobacco use to atherosclerotic disease, it is not surprising that smokers were at a higher risk for restenosis and occlusion as has been previously demonstrated. 16 The presence of a stent in the popliteal segment places a rigid stent at an area of repetitive motion and stress, leading to an increased rate of restenosis, with or without the presence of a stent fracture.…”

“…In particular, patients with anatomically favorable lesions have demonstrated excellent outcomes with endovascular therapy and are often managed with an aggressive endovascular posture. [3][4][5][6][7] However, this enthusiasm for endovascular therapy has been tempered by significant rates of restenosis and occlusion particularly for more advanced lesions. Concomitantly, patients with such complex lesions typically have multiple comorbidities including advanced coronary artery disease and cerebrovascular disease, making them high risk for surgical intervention.…”

“…8,9 Our group has previously reported acceptable results in the interventional treatment of TASC B and C lesions with a mean lesion length of 12 cm. 6 To date, no large series has been published that reports on the results of endovascular intervention for TASC D lesions. The objective of this report was to examine the outcomes of endovascular therapy for the treatment of TASC D femoropopliteal lesions.…”