Endovascular invasions for femoral-popliteal segment disorders of C andD-type according to TASC-II classification
Currently, direct re-vascularization for the management of critical limb ischemia (CLI) is effectuated through open and hybrid surgical treatments. At the same time, therapeutic recommendations for one of the methods appear as a subject of lasting discussions. Today TASC II (TransAtlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease) adopted in 2007 is the most popular document that provides justifications for endovascular and surgical treatment of peripheral arterial disease. Clinical practice provides evidence that there is a significant number of patients having critical limb ischemia who suffer from vascular bed disorders and are classified as C or D-type according to TASC classification. Meanwhile, there also are cases when these patients have no other alternative than re-vascularization by means of open surgery, which is why endovascular invasion appears as the only method of re-vascularization for them. The article presents some results of comparative studies within endovascular and surgical tools aimed at revascularization in the area of femoral-popliteal segment, including cases where patients are classified as C and D-type. The results of shunting operations are compared to angioplasty and remote endarterectomy, whereas technical methods for re-entry during subintimal angioplasty are regarded apart. Despite the fact that there are medical recommendations for the use of endovascular and surgical methods depending on TASC II classification, today there is no evidence that these tools can be efficient in revascularization of femoral-popliteal segment. In order to identify the efficiency of distinct methods in revascularization of femoral-popliteal segment there a need in a number of extended randomized studies designed to evaluate the role of such factors, as anatomic location of the vascular bed disorder, the extent of a disease, the location of purolo-necrotic areas as well as other pathologies on the results of the study.
Brogneaux C, Sprynger M, Magnée M, Lancellotti P; European Society For Cardiology. [2011 ESC guidelines on the diagnosis and treatment of peripheral artery diseases]. Rev. Med. Liege. 2012 Nov;67(11):560-5. French. PubMed PMID:23346824.
Antoniou GA, Georgiadis GS, Antoniou SA et al. Bypass surgery for chronic lower limb ischaemia. Cochrane Database Syst. Rev. 2017 Apr 3;4:CD002000. doi: 10.1002/14651858.CD002000.pub3. Review. Pub Med PMID: 28368090.
Bradbury AW, Adam DJ, Bell J et al.; BASIL trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J. Vasc. Surg. 2010 May;51(5 Suppl):5S-17S. doi: 10.1016/j. jvs.2010.01.073. Erratum in: J Vasc Surg. 2010 Dec;52(6):1751. PubMed PMID: 20435258.
Chang Z, Zheng J, Liu Z. Subintimal angioplasty for lower limb arterial chronic total occlusions. Cochrane Database Syst. Rev. 2016 Nov 18;11:CD009418. Review. PubMed PMID: 27858952.
Lo ZJ, Lin Z, Pua U et al. Diabetic Foot Limb Salvage-A Series of 809 Attempts and Predictors for Endovascular Limb Salvage Failure. Ann. Vasc. Surg. 2018 May;49:9-16. doi: 10.1016/j.avsg.2018.01.061. Epub 2018 Feb 9. PubMed PMID: 29428535.
Dosluoglu HH, Lall P, Harris LM, Dryjski ML. Longterm limb salvage and survival after endovascular and open revascularization for critical limb ischemia after adoption of endovascular-first approach by vascular surgeons. J .Vasc. Surg. 2012 Aug;56(2):361-71. doi: 10.1016/j.jvs.2012.01.054. Epub 2012 May 5. PubMed PMID: 22560307.
Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Section D: chronic critical limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 2000 Jun;19 Suppl A:S144-243. Review. PubMed PMID: 10957907.
Norgren L, Hiatt WR, Dormandy JA et al. TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur. J. Vasc. Endovasc. Surg. 2007;33(suppl 1):S1-75.
This work is licensed under a Creative Commons Attribution 4.0 International License.