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Peripheral lower limb ischemia is a condition that is prevalent worldwide and that is likely to increase with age. The increased prevalence of diabetes mellitus and hypertension in the population is considered to an important risk factor for the spread of peripheral arterial disease (PAD). The lower limb is the most common site of PAD. Because of the unique slow flow and high-resistance environment, the superficial femoral artery (SFA), extending to the proximal popliteal artery segment, is the most affected area. Femoropopliteal occlusive disease is still considered to be the Achilles heel of the vascular specialist.
Bypass surgery is known to be a definitive treatment.Transatlantic Intersociety Consensus (TASC)-II recommends traditional surgical therapy for long superfacial femoral artery type D lesions. However, the main problems of surgery are increased morbidity and rehospitalization rates, being 50%. In addition, patients with more complex, long occlusive lesions often develop significant comorbidities, placing them at a high risk for traditional open surgical bypass.
Recent advances in endovascular techniques have led to the widespread application of endovascular repair for more severe femoral lesions. Even though lesions are more distal and longer, the technical success does not seem to be. Multiple studies have reported technical success rates of more than 90% for TASC-II D lesions
The chronic nature of PAD and the high restenosis rate in many patients with femoropopliteal lesions necessitate repeat interventions, which are an essential part of the long-term treatment.
Endovascular treatment for TASC II D lesions is safe and can be effectively performed with acceptable hemodynamic improvement. Though re-stenosis is very common, close surveillance and repeated intervention can resolve this problem.
TASC II D lesions were defined as chronic total occlusions of the SFA more than 20 cm and involving the popliteal artery or chronic total occlusions of the popliteal artery and proximal trifurcation vessels.
This study was performed to evaluate the outcomes of endovascular therapy for the treatment of TASC-II D superfacial femoral artery lesions. and involved 20 patients underwent endovascular interventions superficial femoral artery lesions in twenty patients with technical success in 18/20 cases (90%), 2 cases failed (1 received bypass , 1 underwent major amputation).
Finally, TASC-II recommendations advocate traditional surgical therapy for the treatment of complex lesions of femoropopliteal segments.. In patients who are not at high risk for surgery, bypass surgery is indicated for long (i.e. >_25 cm) superficial femoral artery lesions when an autologous vein is available and life expectancy is > 2 years. In patients unfit for surgery, endovascular therapy may be considered in long (i.e. >_25 cm) femoro-popliteal lesions.