Endovascular first strategy for de novo TransAtlantic Inter-Society Consensus C and D femoro-popliteal disease: mid-term outcomes from a single tertiary referral center.
OBJECTIVE
Describe outcomes after endovascular intervention of TransAtlantic Inter-Society Consensus C and D femoro-popliteal disease.


METHODS
Retrospective cohort study. Patient demographics, ankle-brachial indices, and lesion details were analyzed from a prospectively maintained database. In all, 980 limbs treated with percutaneous transluminal angioplasty±stenting of the femoro-popliteal segment between 2005 and 2012 were reviewed. Seventy-six patients representing 83 limbs with de novo TransAtlantic Inter-Society Consensus C and D lesions measuring ≥15 cm continuously were identified (mean age 71.3±12.1 years, 62% male).


RESULTS
Twenty-five (30.1%) limbs were treated for severe claudication and 58 (69.9%) for critical limb ischemia. The mean pre-procedural ankle-brachial index was 0.47±0.19. The mean lesion length was 22.9±4.82 cm. Seventy patients representing 77 limbs were available for a mean follow-up length of 19.5 months (range 0-79). The mean post-procedural ankle-brachial index was 0.71±0.28. Primary, assisted-primary, and secondary patency rates were 68.1%, 72.7%, and 83.3% at 6 months, 55.3%, 63.6%, and 58.3% at 12 months, and 38.2%, unavailable, and 10.4% at 24 months, respectively.


CONCLUSIONS
Angioplasty-first strategy for TransAtlantic Inter-Society Consensus C and D lesions of the femoro-popliteal artery can be safely performed. However, patency drastically decreases after 12 months suggesting further improvements are required to achieve longer-term clinical benefit.
Diagnostic Radiology Program, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada jeffreylgrenville@gmail.com.
Jeffrey Lorne
JL
Grenville
Department of Medical Imaging, The University Health Network, Toronto, Ontario, Canada.
Kong Teng
KT
Tan
Department of Medical Imaging, The University Health Network, Toronto, Ontario, Canada.
Hadas
H
Moshonov
Department of Medical Imaging, The University Health Network, Toronto, Ontario, Canada.
Dheeraj Kumar
DK
Rajan
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D055109:Ankle Brachial Index; D002170:Canada; D003251:Constriction, Pathologic; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
Endovascular; TASC-C; TASC-D; femoro-popliteal; stent; superficial femoral artery