Page 8 - Carotid and peripheral vascular interventions textbook
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                    with an exercise program to augment collateral f ow rather     either approach depending on factors such as physician
                    than undergoing intervention therapy for femoropopliteal    experience, the patient status, and technical resources
                    disease. Fewer than one-fourth of these patients will    available. In patients with comorbidities and high risk
                    progress to the stage of developing more disabling     for surgery, an endovascular approach should be applied
                    symptoms or a threatened limb, which mandate therapy.   irrespective of anatomy. Patients with rest pain or
                        Once  revascularization  is  indicated,  deciding     disabling claudication and having multiple levels of disease
                    whether  to  choose  a  surgical  or  an  endovascular    may receive a staged approach with an endovascular-
                    approach is based on the TASC II recommendation.    f rst approach as one stage. In-f ow disease may be
                    The TransAtlantic Inter-Society Consensus (TASC)     corrected f rst, and out-f ow disease may be corrected
                    (16) has classif ed femoropopliteal disease into four     in a staged manner, when needed. Patients whose veins
                    types  (i.e., A-D)  based  on  the  number  of  lesions,    have been harvested for prior coronary artery bypass
                    lesion length, and the presence of stenosis or occlusion   surgery without suitable remaining autologous veins to
                    (Fig. 12-5). The classif cation has def ned lesion length   apply for conduits, should be considered for endovascular
                    as follows: focal (<10cm), intermediate (10-20 cm),   revascularization.
                    and diffuse (>20 cm). This classif cation also proposed       For non-operable severe claudication patients
                    treatment  strategies  and  recommendations  for  the     because of unfavorable anatomy or medical comorbidities,
                    management of the lesions. Type A and type B are advised   only medication treatment is appropriate. Amputation
                    for initial endovascular revascularization, type D lesions   can ameliorate ischemic rest pain and is required
                    advised for surgical revascularization and type C for     when gangrene and signif cant tissue loss is present.

                    Figure  12-5.  The TransAtlantic InterSociety Consensus (TASC) II classif cation for the management of femoropopliteal lesions.
                    (Redrawn from Jaff MR, White CJ, Hiatt WR, et al. An update on methods for revascularization and expansion of the TASC lesion classif cation
                    to include below-the-knee arteries. J Endovasc Ther. 2015;20:465-478, with permission from SAGE Publications.)

                             TASC A lesions
                             • Single stenosis <10 cm in length
                             • Single occlusion <5 cm in length

                             TASC B lesions
                             • Multiple lesions (stenoses or occlusions), each
                               <5 cm
                             • Single stenosis or occlusion <15 cm not
                               involving the infrageniculate popliteal artery
                             • Heavily calcified occlusion <5 cm in length
         336                 • Single popliteal stenosis

                             TASC C lesions
                             • Multiple stenoses or occlusion totaling >15 cm
                               with or without heavy calcification
                             • Recurrent stenoses or occlusions after failing

                             TASC D lesions
                             • Chronic total occlusions of CFA or SFA (>20
                               cm, involving the popliteal artery)
                             • Chronic total occlusion of popliteal artery and
                               proximal trifurcation vessels

                    CFA, common femoral artery; SFA, superf cial femoral artery.
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