Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia
Is endovascular treatment technically feasible and effective in treating TASC II D femoropopliteal lesions in patients with critical limb ischemia?
Endovascular treatment of TASC II D femoropopliteal lesions is feasible and with good results. The primary patency in patients with popliteal artery occlusions involving the trifurcation vessels was better but the need for stent in this subgroup was associated with a low rate of limb salvage.
Biagioni RB, Brandão GD, Biagioni LC, Nasser F, Burihan MC, Ingrund JC. Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia. J Vasc Surg. 2019 Jan 2. pii: S0741-5214(18)32245-6. doi: 10.1016/j.jvs.2018.08.176. [Epub ahead of print] PubMed PMID: 30611581.
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Study design: Retrospective
Funding source: Self-funded or unfunded
Setting: Single center
Fig 1. A, Initial angiogram. A 20-cm occlusion from the middle superficial femoral artery (SFA) to the P2 popliteal segment. B, Arteriography after 5- 100-mm balloon inflation. Limiting flow dissection of the SFA. C, Nitinol 6- 200-mm stent. D, Completion angiogram. E, Diagnostic angiogram. F, After dilation. Note the limiting flow dissection at P3 popliteal segment. G, Spotting stent with a nitinol 4- 8-mm stent. H, Completion angiogram.
This paper presents the results of a retrospective analysis of 91 patients with critical limb ischemia submitted to endovascular treatment of TASC II D lesions involving the femoropopliteal segment. These types of lesions are better suited to surgical repair according to the most recent TransAtlantic Inter-Society Consensus. However, ideal surgical candidates would present with acceptable overall state of health and an appropriate autologous bypass. Therefore, endovascular treatment is the only option for many patients with this condition. The study shows that this approach has high successful recanalization rate (95.7%) and acceptable low complication rate (7.7%). Overall limb salvage, which is the critical clinical outcome in this patient population was comparable to surgical repair. In addition, sub-analysis demonstrated that primary patency in patients with popliteal artery occlusions involving the trifurcation vessels was better compared to isolated SFA lesions, but the need for stent in the popliteal group was associated with low rate of limb salvage. Limitations of the study included the selection bias (only non-surgical candidates) and the utilization of conventional angioplasty balloons and stents instead of drug-coating balloons and drug-eluting stents. However, clinical results were still comparable to surgical repair reinforcing that even complex lesions are suitable for endovascular recanalization which will eventually become the first therapeutic option for all patients.
Ricardo Yamada, MD
Department of Radiology
Division of Vascular and Interventional Radiology
Medical University of South Carolina