Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia

Torres-Blanco, Álvaro; Edo-Fleta, Gemma; Gómez-Palonés, F.J.; Molina-Nácher, Vicente; Ortiz-Monzón, E.

doi:10.1007/s00270-015-1175-3

Cited by 15 publications

(14 citation statements)

References 39 publications

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“…This study includes one of the largest series of patients with TASC II D femoropopliteal lesions treated exclusively with endovascular techniques. 7,8,10,15,22 Furthermore, this is the only article exclusively including patients with critical limb ischemia. Because of this characteristic, the cohort was homogeneous and enabled subgroup analyses with a low possibility of bias.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] In certain cases, however, an endovascular approach can be the best option, especially for high-risk patients. 5,[7][8][9][10][11][12][13] Recent advancements in endovascular techniques and technologies have overcome many technical limitations, and more complex lesions can be successfully treated. 12 In this context, many patients with extensive lesions are now considered for an endovascular-first strategy.…”

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confidence: 99%

“…12 In this context, many patients with extensive lesions are now considered for an endovascular-first strategy. 7,10 Few studies, however, have analyzed the outcomes and technical aspects of this specific population, especially in patients with critical limb ischemia. [6][7][8]12,[14][15][16][17] The aim of this study was to analyze the technical aspects and follow-up outcomes of patients with TASC II D femoropopliteal atherosclerotic disease treated with an endovascular approach.…”

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confidence: 99%

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Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia

Biagioni¹,

Brandão²,

Biagioni³

et al. 2019

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia

Biagioni¹,

Brandão²,

Biagioni³

et al. 2019

Journal of Vascular Surgery

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“…Continuous advances in endovascular techniques and materials have made complex lesions treatable and have led surgeons to attempt an endovascular first strategy in both the inflow and outflow lower extremity arteries. 10,11 However, open CFA endarterectomy remains the gold standard for several reasons, including nature of the plaque, an unfavourable stenting zone being located in a highly flexible area, simultaneous profundaplasty to optimise the runoff, and to provide an access point for inflow and/or outflow endovascular treatment. 12 Initial reports of hybrid procedures date from the 1970s.…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes of Common Femoral Endarterectomy Combined with Inflow and Outflow Endovascular Treatment for Chronic Limb Threatening Ischaemia

Elbadawy

Ali

Saleh

2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis prospective study investigated a group of patients with chronic limb threatening ischaemia due to complex multilevel arterial disease treated homogenously using common femoral endarterectomy combined with inflow and outflow endovascular treatment. This option should provide a great benefit for a subset of high risk patients with an extensive disease pattern as it is considered safe with accepted patency rates despite the need for secondary interventions. Predictors of primary patency loss and degree of limb threat should guide the decision of whether to stage the procedure or perform a simultaneous inflow and outflow complete recanalisation.Objective: To assess mid term outcomes of common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with chronic limb threatening ischaemia (CLTI). Methods: This was a prospective study. All patients who, for the first time, underwent planned one stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularisation procedure to achieve limb salvage in patients with CLTI due to multilevel disease were included between January 2015 and May 2017. Demographics, and clinical and lesion characteristics for each patient were reported. The primary outcome was primary patency. Secondary outcomes were technical success, peri-operative morbidity and mortality, assisted primary patency, secondary patency, clinically driven target lesion revascularisation and amputation free survival. Results: Three groups were created according to the endovascular treatment zone: group 1 (inflow, n ¼ 60); group 2 (outflow, n ¼ 46); and group 3 (combined inflow and outflow, n ¼ 53). CFA endarterectomy was a fixed step in all cases. The overall technical success was 98%. The peri-operative complication rate was 14% and the mortality rate was 2%. Patients in group 3 demonstrated a significantly lower primary patency rate (53.9% AE 7.1%; p < .001) at 24 months but improved secondary patency rate of (94.0% AE 3.4%). Based on the outcomes of the Cox regression multivariable analysis, lesion length (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.06e1.14; p < .001), chronic total occlusion (CTO) (HR 0.50, 95% CI 0.25e0.98; p ¼ .046), peripheral artery calcium scoring system (PACSS) grade 4 (HR 2.44, 95% CI 1.27e4.68; p ¼ .008), incomplete revascularisation (HR 3.32, 95% CI 1.64e6.73; p ¼ .001), and dyslipidaemia (HR 0.50, 95% CI 0.27e0.93; p ¼ .031) were the only significant independent predictors of loss of primary patency. Conclusion: Common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with CLTI is safe, with acceptable patency rates, despite the need for secondary interventions. Dyslipidaemia, lesion length, CTO, PACSS grade 4, and incomplete revascularisation are independent predictors of primary patency loss. The current study analysis supports the recommendation to stage the procedure based on ...

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“…Additionally, these patients often show significant surgical contraindications, such as coronary heart disease and cerebral infarction, that increase the risks associated with surgical revascularization. Numerous clinical studies have shown that EVT is effective in treating TASC II C and D lesions (3)(4)(5)(6)(7)(8)(9). However, while EVT can successfully restore blood flow and improve clinical symptoms, studies have not systematically assessed the correlations between postoperative recurrence and potential risk factors, such as sex, age, smoking, underlying diseases [e.g., diabetes mellitus (DM)], the severity of ischemic symptoms, and TASC classification.…”

Section: Introductionmentioning

confidence: 99%

Mid-term outcomes of endovascular treatment and risk factors for recurrence in patients with Trans-Atlantic-Inter-Society II C/D femoropopliteal lesions

Lin

Liu

et al. 2021

Quant Imaging Med Surg

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Background: The purpose of this study was to determine the efficacy of interventional endovascular treatment (EVT) and the risk factors for postoperative restenosis in patients with Trans-Atlantic Inter-Society Consensus (TASC) II C/D femoropopliteal lesions.Methods: A total of 55 patients who received EVT for TASC Ⅱ C/D femoropopliteal lesions (64 affected limbs) from October 2014 to September 2017 were examined. The mean lesion length was 19.6±5.3 (range, 15.5-26.4 cm). The femoropopliteal lesions were classified as TASC Ⅱ C and TASC Ⅱ D in 39 and 16 cases, respectively. The ankle-brachial index (ABI), primary patency rate, secondary patency rate, and limb salvage rate were monitored in follow-up evaluations for up to 24 months. A Cox regression model was used to evaluate the correlation between each of these factors and the restenosis rate after EVT.Results: Patent TASC Ⅱ C/D femoropopliteal lesions were present in 59 of the 64 limbs. The mean ABI values for the dorsal pedal artery and posterior tibial artery increased 1 month after treatment from a baseline level of 0.35±0.12 to 0.89±0.10 and from 0.43±0.15 to 0.90±0.13, respectively (P<0.01). The mean follow-up time was 19.3 (range, 6-24) months. The cumulative primary patency rates at 1, 3, 6, 12, 18, and 24 months were 98.3%, 91.5%, 84.3%, 61.1%, 53.1%, and 31.1%, respectively. The secondary patency rates at 12 and 24 months were 70.4% and 60.0%, respectively. Factors with a high hazard ratio included male sex, TASC II D, smoking, and diabetes mellitus (DM).Conclusions: EVT had a safe and satisfactory mid-term therapeutic effect on TASC II C/D femoropopliteal lesions. Male sex, TASC II D (compared to TASC II C), smoking, and DM were risk factors for restenosis. EVT has a secondary patency rate comparable to that of open surgery and can be considered a first-line treatment for TASC II C/D femoropopliteal lesions.

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Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia

Cited by 15 publications

References 39 publications

Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia

Endovascular treatment of TransAtlantic Inter-Society Consensus II D femoropopliteal lesions in patients with critical limb ischemia

Midterm Outcomes of Common Femoral Endarterectomy Combined with Inflow and Outflow Endovascular Treatment for Chronic Limb Threatening Ischaemia

Mid-term outcomes of endovascular treatment and risk factors for recurrence in patients with Trans-Atlantic-Inter-Society II C/D femoropopliteal lesions

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