The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions

Background: Advances in technology and practice have led to increased endovascular management of all TransAtlantic Society Consensus (TASC)-graded lesions. This study aims to evaluate the success of endovascular therapy in the management of TASC-graded femoropopliteal lesions. Methods: Patients undergoing endovascular treatment for femoropopliteal lesions between July 1999 and August 2008 were divided by TASC scores and evaluated for primary, assisted-primary, and secondary patency rates at 12 and 24 months. Secondary endpoints included limb loss and postoperative complications. Results: A total of 499 femoropopliteal lesions in 427 patients were treated with endovascular interventions. Score distribution for TASC type A, type B, type C, and type D lesions was 26 (5.2%), 140 (28.1%), 168 (33.7%), and 165 (33.1%), respectively. Primary, assisted-primary, and secondary patency rates at 24 months were 77.7 ± 3.2%, 78.9 ± 3.2%, and 86.7 ± 2.6%, respectively, for TASC type A + B lesions, 76.0 ± 3.3%, 77.2 ± 3.2%, and 85.0 ± 2.8%, respectively, for TASC type C lesions, and 61.2 ± 3.8%, 61.2 ± 3.8%, and 78.2 ± 3.2%, respectively, for TASC type D lesions. Compared with TASC type A + B and TASC type C lesions, TASC type D lesions were associated with worse primary and assisted-primary patency rates. However, there was no statistically significant difference in secondary patency between TASC type A + B and TASC type D lesions. The TASC score was not a significant predictor of postoperative complication rates. The 24-month limb salvage rate in patients with TASC type D lesions presenting with critical limb ischemia was 71.9 ± 8.0%. Conclusion: It was observed that all femoropopliteal lesions can be safely and effectively managed with endovascular therapy. Although TASC type D lesions do have lower primary and assisted-primary patency rates, high secondary patency rates comparable with other TASC scores can be achieved with effective prevention of limb loss. These data provide evidence to support endovascular therapy as primary management for all femoropopliteal lesions regardless of the TASC score.