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Updated guidelines address new changes in PAD management
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A group of experts recently published an update to the Inter-Society Consensus for the Management of Peripheral Arterial Disease, or TASC II, providing a complete classification on anatomic lower limb lesions and an update on new endovascular techniques and practice patterns.
The TASC II guidelines, which represent the collaboration of international vascular specialties, were published in 2007. At that time, the TASC II document did not clearly reflect the adoption of endovascular therapy as the primary strategy for treating symptomatic PAD, according to the authors.
“There has been an increase in adoption of the endovascular-first strategy for
even the most complex anatomies (ie, TASC D) in the clinical practice of endovascular specialists, decreasing the number of anatomies that are primarily referred for open surgical revascularization,” TASC Steering Committee member Michael R. Jaff, DO, of Massachusetts General Hospital and a Cardiology Today’s Intervention Editorial Board member, and colleagues wrote. “This shift was not clearly reflected in TASC II, a fact that has been criticized.”
Michael R. Jaff
This omission, along with the lack of infrapopliteal arteries in the lesion classification, led the authors to publish an update to TASC II.
The new guidelines provide a contemporary review of literature on aortoiliac, femoropopliteal and infrapopliteal diseases, addressing open vs. endovascular repair and choice of revascularization method for each disease.
“An important issue is that both for endovascular and open surgical procedures, there is a difference between what can be done in centers of excellence involved in the development of refined and simplified procedures and what should be completed in everyday practice,” the authors wrote.
In addition, they reviewed TASC classifications for A to D lesions, which now include infrapopliteal lesions.
“The new infrapopliteal lesion classification incorporates several features that attempt to address the multivessel nature of possible infrapopliteal anatomies,” the authors wrote.
Jaff and colleagues added that TASC continues to highlight the limitations of the current endovascular and comparative surgical literature.
“It is critical that future clinical trials with appropriate design, inclusive of patients with common clinical and anatomic patterns of PAD, measure meaningful functional outcomes in addition to presenting information regarding anatomic patency,” they concluded.
The update to the TASC II guidelines was published in the Journal of Endovascular Therapy. – by Brian Ellis
Disclosure: The development of this TASC II supplement was supported by unrestricted educational grants awarded to Discovery London from Aastrom Biosciences, Abbott Vascular, AnGes MG Inc., Bayer Schering Pharma, Biomedix, Cook, ev3, Medtronic, Mitsubishi Tanabe, Otsuka Pharmaceutical Co., Sanofi-Aventis and Toray Industries. Please see the full version of the update for the authors’ relevant financial disclosures.
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