Stenting vs above knee polytetrafluoroethylene bypass for TransAtlantic Inter-Society Consensus-II C and D superficial femoral artery disease.
OBJECTIVE
TransAtlantic Society Consensus (TASC)-II recommends bypass for TASC D and low-risk patients with TASC C lesions but does not specify graft types. Percutaneous balloon angioplasty/stenting (PTA/S) and above knee femoropopliteal bypass (AK-FPB) using polytetrafluoroethylene (PTFE) for these lesions were compared to determine if graft type should be part of the TASC-II recommendations for the treatment of TASC C lesions.


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 June 2001 and April 2007 were retrospectively analyzed. The primary end points were primary, assisted-primary, and secondary patency rates.


RESULTS
In 127 patients (mean age, 68.7 +/- 10.0 years; median, 68; range, 49-97), 139 limbs were treated (46 AK-FPB, 49 PTA/S-C, 44 PTA/S-D). The mean occlusion and stented lengths were 9.9 +/- 3.8 and 24.3 +/- 6.6 cm (median, 10 and 20 cm) in PTA/S-C, and 26.6 +/- 5.5 and 30.0 +/- 5.2 cm (median, 26 and 29 cm) in PTA/S-D. Technical success was 84% in PTA/S-D and 100% in other groups. Mean follow-up was 26.4 +/- 18.0 months (median, 24). The 12- and 24-month primary patency was 83% +/- 6% and 80% +/- 7% for PTA/S-C; 54% +/- 8% and 28% +/- 12% for PTA/S-D; and 81% +/- 6% and 75% +/- 7% for AK-FPB (P < .001 PTA/S-D vs PTA/S-C and AK-FPB); assisted-primary patency was 95% +/- 3% and 95% +/- 3% for PTA/S-C, 62% +/- 8% and 49% +/- 10% for PTA/S-D, and 81% +/- 6% and 75% +/- 7% for AK-FPB (P < .001, PTA/S-C vs PTA/S-D; P = .003, PTA/S-C vs AK-FPB; and P = .03, PTA/S-D vs AK-FPB). Secondary patency was 98% +/- 3% and 98% +/- 3% for PTA/S-C; 72 % +/- 7% and 54% +/- 11% for PTA/S-D, and 81% +/- 6% and 78% +/- 7% for AK-FPB. Secondary patency was significantly better in PTA/S-C than AK-FPB (P = .003) and PTA/S-D groups (P < .001). The difference was marginally better in AK-FPB than in PTA/S-D (P = .064).


CONCLUSIONS
PTA/S for TASC-II C lesions has a superior midterm patency than AK-FPB using PTFE, and AK-FPB with PTFE has better primary and assisted-primary patency than PTA/S-D. The TASC-II recommendations should be modified to recommend treatment of SFA TASC-II C lesions by PTA/S rather than PTFE bypass for all patients. PTA/S of TASC-II D lesions should only be considered in high-risk patients who cannot tolerate a bypass procedure using PTFE.
Dosluoglu
Hasan H
HH
Division of Vascular Surgery, Department of Surgery, VA Western New York Healthcare System, Buffalo, NY 14215, USA. dosluoglu@yahoo.com
Cherr
Gregory S
GS
Lall
Purandath
P
Harris
Linda M
LM
Dryjski
Maciej L
ML
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011138:Polytetrafluoroethylene; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D011138:Polytetrafluoroethylene