A 65-year-old diabetic smoker presents with Fontaine Stage IIb critical limb ischaemia (claudication at 80 metres) and an ankle-brachial index of 0.55. Duplex imaging shows a 7 cm stenosis in the superficial femoral artery at Hunter's canal. According to TASC II classification, this lesion is classified as TASC C. Which management approach is preferred?
- A Conservative management and supervised exercise programme
- B Endovascular treatment (angioplasty with stenting) as first choice for TASC C lesions
- C Primary amputation due to TASC C disease in a diabetic patient
- D Surgical bypass (femoro-popliteal bypass with autologous vein) as preferred treatment for TASC C/D lesions ✓
Explanation
TASC II (Trans-Atlantic Inter-Society Consensus) classification guides management: TASC A/B lesions favour endovascular treatment; TASC C/D lesions favour surgical bypass. A 7 cm SFA occlusion/stenosis at Hunter's canal is TASC C. For claudication with TASC C lesions, the preferred treatment is surgical femoro-popliteal bypass using autologous great saphenous vein, which has superior patency compared to prosthetic graft (5-year patency ~70-75% above-knee vein vs ~50% PTFE above-knee). Conservative management with supervised exercise is appropriate for Fontaine IIa (claudication >200 m), but IIb requires revascularisation consideration.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.