title: Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia.
abstract: OBJECTIVE
  The purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI).
  
  
  METHODS
  Patients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan-Meier estimation and predictors of restenosis/occlusion with Cox analysis.
  
  
  RESULTS
  Thirty-two patients underwent treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76%, whereas estimated primary and secondary patency rates were 41 and 79%, respectively.
  
  
  CONCLUSIONS
  Endovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.
authors.affiliation: Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario Dr. Peset, Av/Gaspar Aguilar 90, 46017, Valencia, Spain. atorres658@yahoo.es.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Torres-Blanco
authors.affiliation: Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario Dr. Peset, Av/Gaspar Aguilar 90, 46017, Valencia, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Edo-Fleta
authors.affiliation: Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario Dr. Peset, Av/Gaspar Aguilar 90, 46017, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gómez-Palonés
authors.affiliation: Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario Dr. Peset, Av/Gaspar Aguilar 90, 46017, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Molina-Nácher
authors.affiliation: Department of Angiology, Endovascular and Vascular Surgery, Hospital Universitario Dr. Peset, Av/Gaspar Aguilar 90, 46017, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz-Monzón
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Endovascular; Femoropopliteal; Limb ischemia; Peripheral artery disease; Revascularization; Stenting