Print this pageBalloon Angioplasty/Stenting of TASC (II) C Lesions of SFA is Superior to Femoral-above-the-knee-popliteal Bypass with PTFE
Back to Program
Hasan H. Dosluoglu, MD1, Gregory S. Cherr, MD2, Purandath Lall, MD1, Linda M. Harris, MD2, Maciej L. Dryjski, MD1.
1SUNY at Buffalo, VA Western N Y Healthcare System, Buffalo, NY, USA, 2SUNY at Buffalo, Buffalo, NY, USA.
Objectives: TASC II recommends bypass for TASC D and low risk TASC C patients, however doesn’t differentiate graft types. We compared percutaneous balloon angioplasty/stenting (PTA/S) and above-knee femoropopliteal bypass (AK-FPB) using PTFE to determine the validity of TASC II in this subgroup.
Methods: Consecutive patients who underwent AK-FPB with PTFE, or PTA/S for TASC-II C (PTA/S-C) or D (PTA/S-D) SFA lesions between 6/2001-4/2007 were identified from our database. Groups were compared for demographics and outcomes (intent-to-treat) using t-test and Kaplan-Meier analysis (SPSS).
Results: 139 limbs (127 patients) were treated (46 AK-FPB, 49 PTA/S-C, 44 PTA/S-D). The mean age was 68.7±10.0, less for AK-FPB than other groups. Renal insufficiency and critical limb ischemia were more common in PTA/S groups, while active smoking and runoff score were significantly higher in AK-FPB. The mean occlusion and stented lengths were 9.9±3.8cm, 24.3±6.6cm in PTA/S-C, and 26.6±5.5cm, 30.0±5.2cm in PTA/S-D. Technical success was 84% in PTA/S-D and 100% in other groups. Mean follow-up was 24.8±18.5 months. Assisted-primary (APP) and secondary (SP) patency of PTA/S-C was significantly better than AK-FPB and PTA/S-D. 24-month PP was better in AK-FPB (73±7%) and PTA/S-C (84±6%) than PTA/S-D (52±8), APP and SP were similar between AK-FPB and PTA/S-D.
Conclusions: PTA/S for TASC C lesions has a superior mid-term patency than AK-FPB. PTA/S-D has similar APP and SP with AK-FPB using PTFE. We suggest TASC-II recommendations be modified to recommend TASC C lesions of SFA, and high-risk patients with TASC D lesions be treated using PTA/S rather than PTFE bypass.
| AK-FPB | PTA/S-C | PTA/S-D | P value | |
| Age | 64.7±8.0 | 71.6±10.4* | 69.4±10.2* | *<0.02 vs AK-POP |
| Renal insufficiency (Cr>1.5mg/dL) | 7% | 31% | 20% | 0.032 |
| Active smoker | 67% | 37% | 39% | 0.002 |
| CLI | 43% | 80% | 73% | 0.001 |
| Runoff score | 2.1±0.7 | 1.7±0.8* | 1.8±0.7** | *0.028, **0.056 vs AK-POP |
| PP (24 mo) | 73±7% | 84±6% | 46±9.6% | <0.001 |
| APP (24 mo) | 78±7% | 98±2% | 62±8% | <0.001 |
| SP (24 mo) | 81±6% | 100% | 66±9% | <0.001 |
| LS (24 mo) | 95±3% | 95±3% | 88±6% | NS |
Back to Annual Symposium
Back to Program