A 60-year-old male with peripheral arterial disease has an ankle-brachial pressure index (ABPI) of 0.45 with rest pain. CT angiography shows a long segment SFA occlusion (TASC II class D). Which treatment modality is recommended by TASC II guidelines?
- A Primary percutaneous transluminal angioplasty (PTA) with drug-coated balloon
- B Amputation due to non-reconstructable disease
- C Surgical bypass (preferably femoro-popliteal vein graft) is recommended for TASC D lesions ✓
- D Conservative management with supervised exercise therapy
Explanation
TASC (Trans-Atlantic Inter-Society Consensus) II classification stratifies femoropopliteal lesions by complexity: Type A (short stenoses) is best treated by endovascular means; Type D (long occlusions >20 cm, including complete SFA occlusion) is best treated by open surgical bypass when the patient is a suitable surgical candidate. Femoro-popliteal bypass using ipsilateral great saphenous vein (GSV) is the gold standard for TASC D disease with rest pain (CLI), achieving 5-year primary patency of 70-80% compared to 40-60% for prosthetic grafts. Drug-eluting stents and drug-coated balloons have improved endovascular results but long TASC D lesions with CLI still have superior outcomes with surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.