Midterm Outcomes after Infrapopliteal Interventions in Patients with Critical Limb Ischemia Based on the TASC II Classification of Below-the-Knee Arteries

Gagan Singh, Ellen K. Brinza, Justin Hildebrand, Stephen W. Waldo, T. Raymond Foley, John R. Laird, Ehrin J. Armstrong

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To analyze the relationship between the new TransAtlantic Inter-Society Consensus (TASC II) infrapopliteal classification and limb outcomes among patients with critical limb ischemia (CLI). Methods: A single-center retrospective study was performed on 166 consecutive CLI patients (mean age 71 years; 113 men) undergoing endovascular treatment of 244 infrapopliteal lesions from 2006 to 2013. Patient, procedural, angiographic, and limb outcomes were compared for the new TASC A/B vs C/D classification for infrapopliteal lesions. Binary restenosis was determined by a peak systolic velocity ratio >2.0 by duplex ultrasound on follow-up at 1, 3, 6, and 12 months. Results: Seventy-two (43.4%) patients had TASC A/B lesions, while 94 (56.6%) had TASC C/D patterns of infrapopliteal disease. Baseline demographics and tissue loss (93% vs 94%, p=0.59) were similar between the groups. TASC A/B lesions were shorter (53±35 vs 170±83 mm, p<0.001), less severely stenosed (77%±24% vs 93%±14%, p<0.001), had a larger target vessel diameter (2.9±0.5 vs 2.6±0.5 mm, p<0.001), and were less frequently chronic total occlusions (24% vs 64%, p<0.001) compared with the TASC C/D group. Three-year freedom from both amputation (85% vs 67%, p=0.02) and major adverse limb events (79% vs 61%, p=0.02) were significantly higher in the TASC A/B group. Technical success rates (95% vs 80%, p<0.001) and 1-year primary patency (58% vs 51%, p=0.04) were higher in the A/B group. Overall 3-year survival was similar between the groups (96% A/B vs 88% C/D, p=0.2). Conclusion: TASC C/D infrapopliteal lesions are associated with higher amputation and major adverse limb events rates and lower primary patency compared with TASC A/B infrapopliteal lesions. Further studies are needed to assess the association between TASC C/D infrapopliteal lesions and clinical outcomes in patients with CLI.

Original languageEnglish (US)
Pages (from-to)321-330
Number of pages10
JournalJournal of Endovascular Therapy
Volume24
Issue number3
DOIs
StatePublished - Jun 1 2017

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Knee
Ischemia
Extremities
Arteries
Amputation
Retrospective Studies
Demography
Survival

Keywords

  • amputation
  • angioplasty
  • critical limb ischemia
  • infrapopliteal arteries
  • occlusion
  • patency
  • stenosis
  • survival
  • TASC classification

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Midterm Outcomes after Infrapopliteal Interventions in Patients with Critical Limb Ischemia Based on the TASC II Classification of Below-the-Knee Arteries. / Singh, Gagan; Brinza, Ellen K.; Hildebrand, Justin; Waldo, Stephen W.; Foley, T. Raymond; Laird, John R.; Armstrong, Ehrin J.

In: Journal of Endovascular Therapy, Vol. 24, No. 3, 01.06.2017, p. 321-330.

Research output: Contribution to journalArticle

Singh, Gagan ; Brinza, Ellen K. ; Hildebrand, Justin ; Waldo, Stephen W. ; Foley, T. Raymond ; Laird, John R. ; Armstrong, Ehrin J. / Midterm Outcomes after Infrapopliteal Interventions in Patients with Critical Limb Ischemia Based on the TASC II Classification of Below-the-Knee Arteries. In: Journal of Endovascular Therapy. 2017 ; Vol. 24, No. 3. pp. 321-330.
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abstract = "Purpose: To analyze the relationship between the new TransAtlantic Inter-Society Consensus (TASC II) infrapopliteal classification and limb outcomes among patients with critical limb ischemia (CLI). Methods: A single-center retrospective study was performed on 166 consecutive CLI patients (mean age 71 years; 113 men) undergoing endovascular treatment of 244 infrapopliteal lesions from 2006 to 2013. Patient, procedural, angiographic, and limb outcomes were compared for the new TASC A/B vs C/D classification for infrapopliteal lesions. Binary restenosis was determined by a peak systolic velocity ratio >2.0 by duplex ultrasound on follow-up at 1, 3, 6, and 12 months. Results: Seventy-two (43.4{\%}) patients had TASC A/B lesions, while 94 (56.6{\%}) had TASC C/D patterns of infrapopliteal disease. Baseline demographics and tissue loss (93{\%} vs 94{\%}, p=0.59) were similar between the groups. TASC A/B lesions were shorter (53±35 vs 170±83 mm, p<0.001), less severely stenosed (77{\%}±24{\%} vs 93{\%}±14{\%}, p<0.001), had a larger target vessel diameter (2.9±0.5 vs 2.6±0.5 mm, p<0.001), and were less frequently chronic total occlusions (24{\%} vs 64{\%}, p<0.001) compared with the TASC C/D group. Three-year freedom from both amputation (85{\%} vs 67{\%}, p=0.02) and major adverse limb events (79{\%} vs 61{\%}, p=0.02) were significantly higher in the TASC A/B group. Technical success rates (95{\%} vs 80{\%}, p<0.001) and 1-year primary patency (58{\%} vs 51{\%}, p=0.04) were higher in the A/B group. Overall 3-year survival was similar between the groups (96{\%} A/B vs 88{\%} C/D, p=0.2). Conclusion: TASC C/D infrapopliteal lesions are associated with higher amputation and major adverse limb events rates and lower primary patency compared with TASC A/B infrapopliteal lesions. Further studies are needed to assess the association between TASC C/D infrapopliteal lesions and clinical outcomes in patients with CLI.",
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AU - Singh, Gagan

AU - Brinza, Ellen K.

AU - Hildebrand, Justin

AU - Waldo, Stephen W.

AU - Foley, T. Raymond

AU - Laird, John R.

AU - Armstrong, Ehrin J.

PY - 2017/6/1

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N2 - Purpose: To analyze the relationship between the new TransAtlantic Inter-Society Consensus (TASC II) infrapopliteal classification and limb outcomes among patients with critical limb ischemia (CLI). Methods: A single-center retrospective study was performed on 166 consecutive CLI patients (mean age 71 years; 113 men) undergoing endovascular treatment of 244 infrapopliteal lesions from 2006 to 2013. Patient, procedural, angiographic, and limb outcomes were compared for the new TASC A/B vs C/D classification for infrapopliteal lesions. Binary restenosis was determined by a peak systolic velocity ratio >2.0 by duplex ultrasound on follow-up at 1, 3, 6, and 12 months. Results: Seventy-two (43.4%) patients had TASC A/B lesions, while 94 (56.6%) had TASC C/D patterns of infrapopliteal disease. Baseline demographics and tissue loss (93% vs 94%, p=0.59) were similar between the groups. TASC A/B lesions were shorter (53±35 vs 170±83 mm, p<0.001), less severely stenosed (77%±24% vs 93%±14%, p<0.001), had a larger target vessel diameter (2.9±0.5 vs 2.6±0.5 mm, p<0.001), and were less frequently chronic total occlusions (24% vs 64%, p<0.001) compared with the TASC C/D group. Three-year freedom from both amputation (85% vs 67%, p=0.02) and major adverse limb events (79% vs 61%, p=0.02) were significantly higher in the TASC A/B group. Technical success rates (95% vs 80%, p<0.001) and 1-year primary patency (58% vs 51%, p=0.04) were higher in the A/B group. Overall 3-year survival was similar between the groups (96% A/B vs 88% C/D, p=0.2). Conclusion: TASC C/D infrapopliteal lesions are associated with higher amputation and major adverse limb events rates and lower primary patency compared with TASC A/B infrapopliteal lesions. Further studies are needed to assess the association between TASC C/D infrapopliteal lesions and clinical outcomes in patients with CLI.

AB - Purpose: To analyze the relationship between the new TransAtlantic Inter-Society Consensus (TASC II) infrapopliteal classification and limb outcomes among patients with critical limb ischemia (CLI). Methods: A single-center retrospective study was performed on 166 consecutive CLI patients (mean age 71 years; 113 men) undergoing endovascular treatment of 244 infrapopliteal lesions from 2006 to 2013. Patient, procedural, angiographic, and limb outcomes were compared for the new TASC A/B vs C/D classification for infrapopliteal lesions. Binary restenosis was determined by a peak systolic velocity ratio >2.0 by duplex ultrasound on follow-up at 1, 3, 6, and 12 months. Results: Seventy-two (43.4%) patients had TASC A/B lesions, while 94 (56.6%) had TASC C/D patterns of infrapopliteal disease. Baseline demographics and tissue loss (93% vs 94%, p=0.59) were similar between the groups. TASC A/B lesions were shorter (53±35 vs 170±83 mm, p<0.001), less severely stenosed (77%±24% vs 93%±14%, p<0.001), had a larger target vessel diameter (2.9±0.5 vs 2.6±0.5 mm, p<0.001), and were less frequently chronic total occlusions (24% vs 64%, p<0.001) compared with the TASC C/D group. Three-year freedom from both amputation (85% vs 67%, p=0.02) and major adverse limb events (79% vs 61%, p=0.02) were significantly higher in the TASC A/B group. Technical success rates (95% vs 80%, p<0.001) and 1-year primary patency (58% vs 51%, p=0.04) were higher in the A/B group. Overall 3-year survival was similar between the groups (96% A/B vs 88% C/D, p=0.2). Conclusion: TASC C/D infrapopliteal lesions are associated with higher amputation and major adverse limb events rates and lower primary patency compared with TASC A/B infrapopliteal lesions. Further studies are needed to assess the association between TASC C/D infrapopliteal lesions and clinical outcomes in patients with CLI.

KW - amputation

KW - angioplasty

KW - critical limb ischemia

KW - infrapopliteal arteries

KW - occlusion

KW - patency

KW - stenosis

KW - survival

KW - TASC classification

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