A 65-year-old man with critical limb ischemia (rest pain, ABI 0.35) has a CT angiogram showing an isolated occlusion of the superficial femoral artery from its origin to the distal popliteal artery (segment length 24 cm). The femoral and tibial vessels are patent. The most appropriate revascularization strategy according to current TASC II/ESVS guidelines is:
- A Percutaneous transluminal angioplasty (PTA) alone
- B Stenting across the occluded segment (SFA stent)
- C Supervised exercise therapy for 3 months before considering intervention
- D Bypass surgery using reversed great saphenous vein graft (femoropopliteal above-knee bypass) ✓
Explanation
TASC II classifies SFA lesions by complexity: Type D includes total occlusions of the SFA >20 cm, which are best treated by bypass surgery for critical limb ischemia. Long SFA occlusions (>15-20 cm) have inferior patency with endovascular techniques compared to bypass with autologous vein. Reversed great saphenous vein femoropopliteal bypass offers 5-year primary patency of 65-70% above-knee and 50-60% below-knee. Exercise therapy is appropriate for intermittent claudication, NOT critical limb ischemia (tissue loss/rest pain). ESVS 2019 guidelines recommend revascularization within 2 weeks for critical limb-threatening ischemia.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.