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KMID : 0904020100260020090
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Journal of Korean Society for Vascular Surgery
2010 Volume.26 No. 2 p.90 ~ p.97
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Outcomes of Bypass Surgery Versus Endovascular Therapy for TASC II C and D Femoro-Popliteal Lesions in Patients with Chronic Limb Ischemia
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Shin Sung-Hwan
Kwon Se-Hwan
Cho Jin-Hyun
Ahn Hyung-Joon
Oh Joo-Hyung
Park Ho-Chul
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Abstract
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Purpose: We wanted to define the appropriate treatment modalities for Trans-Atlantic Inter-Society Consensus (TASC) II C and D femoro-popliteal lesions. So we compared the primary patency rate and several clinical factors between percutaneous balloon angioplasty with or without stenting (PTA/S) and bypass surgery (BP).
Methods: We reviewed the medical records of patients who underwent BP or PTA/S for TASC II C (BP-C, PTA/S-C) and D (BP-D, PTA/S-D) femoro-popliteal lesions from March 2001 to May 2009. We analyzed the primary and secondary patency rates, and the major limb salvage rates.
Results: Eighty two limbs in 74 patients (mean age: 68.7±10.2 years, males: 82.9%) were treated (PTA/S-C: 18, PTA/S-D 19: BP-C 12, BP-D 33). The mean follow-up duration was 30.0±19.0 months. The twenty four month primary patency rates was 82.4% for PTA/S-C and 73.3% for BP-C (P=0.876), and 45.3% for PTA/S-D and 66.6% for BP-D (P=0.034). The twenty four month secondary patency rates were 88.2% for PTA/S-C and 73.3% for BP-C (P=0.669), and 54.7% for PTA/S-D and 73.3% for BP-D (P=0.077). The twenty four month major limb salvage rates were 100.0% for PTA/S-C and 75.0% for BP-C (P=0.030) but there were no statistical differences between the TASC II D groups (P=0.377).
Conclusion: Bypass surgery is a preferred initial therapeutic option for TASC II D femoro-popliteal lesions. However, several clinical factors must be carefully considered when selecting the primary treatment modality for TASC II C lesions.
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KEYWORD
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Peripheral arterial occlusive disease, Femoro-popliteal lesion, Endovascular therapy, Bypass surgery
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