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OBJECTIVE:
TransAtlantic Inter-Society consensus (TASC) II femoropopliteal classification has been shown to influence the patency of isolated femoropoliteal interventions. The outcomes of simultaneous treatment of proximal arterial disease during tibial intervention and the impact of femoropopliteal TASC classification on these interventions has not been well defined. The purpose of this study was to determine the impact of multisegment disease and femoropopliteal TASC classification on tibial intervention outcomes.
METHODS:
We performed a retrospective review of all tibial interventions completed between 2008- 2011 at 8 hospitals. Outcomes evaluated were primary patency, assisted primary patency, secondary patency, amputation free survival (AFS) and mortality. Statistical analysis was carried out using Kaplan-Meier survival curves Fisher exact and χ(2) tests.
RESULTS:
In our cohort, 671 limbs in 600 patients underwent tibial intervention. Of these, 290 had isolated tibial interventions (ITI), while 381 had simultaneous tibial and proximal femoropopliteal interventions, what we term multisegment interventions (MSI). The primary patency and AFS for the MSI subset was 57% and 86% at 1year and 49% and 80% at 2 years (p=.41 and p=.07) . The primary patency and AFS for the ITI subset was 54% and 77% at 1year and 48% and 72% at 2 years (p=.41 and p=.07) . Univariate analysis demonstrated that TASC classification had no significant impact on primary patency (A=46.7% , B=56.6%, C=43.6%, D=52.1%) and amputation free survival (A=90% , B=81.1%, C=78.7%, D=80.7%). While, proximal stenting had no impact on primary patency or major amputation, our analysis showed that the placement of a proximal stent negatively impacted secondary patency at 12 and 24 months (hazard ratio 2.55, p=.03), however this did not translate into worse AFS (P=.76) or lengthen time to bypass (P=0.5). The final factor of significance we identified was the presence of tissue loss, which had a negative impact on primary patency (58.7% vs 46.7% p=0.04) at one year.
CONCLUSIONS:
Neither femoropopliteal TASC classification, nor the presence of a femoropopliteal stent had a significant impact on primary patency or AFS within multisegment interventions. Stents placed in the femoralpopliteal segment did not worsen primary patency or AFS in these patients. We believe that treatement of multilevel disease provides similar outcomes to those with isolated tibial vessel treatment.