Early and mid term results of endovascular therapy of TASC type B and C femoropopliteal disease; the role for hemodynamic surveillance

ABSTRACT

Endovascular therapy of moderate femoropopliteal arterial occlusive disease remains controversial. This study reviewed our experience with endovascular therapy for TransAtlantic InterSociety Consensus [TASC] type B and C disease. Stenosis free patency was used as an objective end point to evaluate the hemodynamic success. Since January 2001 through January 2004, all patients who had endovascular therapy for their intractable lower limb ischemia due to TASC type B and C femoropopliteal occlusive disease presenting to Dr Erfan and Bagedo Hospitals, Jeddah; KSA, were examined. All had either MRA or CT angiography as a method of pretreatment evaluation. Balloon angioplasty was used initially in all patients and stenting was used selectively as an adjunct to suboptimal angioplasty. The treated segments were examined with duplex ultrasound scanning at 1, 6, 12, and 18 months intervals. Stenosis free patency was defined as the absence of stenosis greater than 50% diameter in the treated segment with standard Duplex criteria. Forty one limbs in 38 patients were studied. The indications for treatment were claudication in 19 limbs [46.3%], minor tissue loss in 13 limbs [31.7%] while rest pain and major tissue loss in 22%. Single lesions were present in 22 limbs and multiple lesions in the rest. Selective stenting were used in 33 limbs where in 9 of them more than one stent were used. Balloon angioplasty alone was performed in 8 limbs. Endovascular therapy was technically successful in all but one patient [97.4%], and there were no perioperative mortality. During follow up recurrent stenosis was detected in 9 limbs [21.9%]. Two patients [4.8%] underwent surgical bypass due to endovascular failure while others had repeat endovascular therapy. Stenosis free patency was 100%, 92.3%, 87.5% and 78.5% by 1, 6, 12, and 18 months intervals. No statistical difference was recorded among either balloon angioplasty or those who required stenting. Regression analysis showed that Peak Systolic Velocity measurement is a good predictor for endovascular outcome. Endovascular therapy appears to be a reasonable treatment option for TASC type B and C femoropopliteal occlusive disease. In our series endovascular therapy proved a technically feasible and safe modality, and achieved clinical improvement in most patients. Recurrent stenosis not reocclusion was the most common study end point due to the virtue of the use of hemodynamic assessment of peak systolic velocity measure and most of them were redirected to repeat endovascular treatment thus fewer patients required surgical revascularization. Although treatment durability in this study was limited yet most patients has documented stenosis free patency at 18 months