الفهرس 
COVEROnly 14 pages are availabe for public view
 |  | from | 171 |  |  |
| | | from | 171 | | |
Abstract
The treatment of infrainguinal arterial disease is the most controversial and perhaps one of the most evolutionary areas of vascular medicine. Several recent advances in our understanding of infrainguinal disease have modified patient care. Studies focusing on non-traditional endpoints, such as quality of life, functional status, and maintenance of independent living, challenge our emphasis on traditional endpoints of patency, limb salvage, or mortality. the development of devices and tools that increase the technical success of endovascular therapies has enabled clinicians to treat complex and longer lesions successfully. The vascular workforce has also changed, with many more vascular specialists being able to offer treatment than ever before. The advanced disease present in CLI patients is representative of a systemic disease burden that leads to significant physical morbidity and mortality. The preferred treatment strategy must also minimize social, psychological, and functional burden of the disease.
Endovascular treatments result in shorter hospital stays, less need for nursing home or assisted-living environments, and less functional disability, providing further incentive to consider a PTA-first strategy.
The Trans-Atlantic Inter-Society Consensus (TASC I and II) documents attempt to determine a treatment preference for femoropopliteal disease based on lesion severity. Simple lesions (TASC-A) should be treated with an endovascular approach, and TASC-D lesions should be treated with a surgery-first approach based on available evidence. The TASC-B and TASC-C lesions represent the middle of the spectrum, and treatment bias toward PTA-first for TASC-B and surgery-first for TASC-C lesions. As an example, shorter superficial femoral artery (SFA) lesions are defined in TASC II as less than 15 cm in length rather than 5 to 10 cm as in TASC I.
With these consensus documents and position papers, the treatment strategy must be individualized to the specific patient, with endovascular therapy viewed as complimentary rather than competitive to traditional open surgery (bypass, endarterectomy). Important factors to consider include the anatomical level of disease (TASC classification), the degree of ischemia at presentation (e.g., claudication, rest pain, or gangrene), the functional status (e.g., ambulatory, homebound, or bedridden), comorbidities (e.g., obesity, heart disease, or age), and technical factors (e.g., bypass target or integrity of autologous vein).