Femoro popliteal bypass Vs angioplasty in TASC D lesion in endovascular ERA. Is it time to change the TASC recommendations?

Abstract

The overall recommendation is that severe limb ischemia patients with long life expectancy and useable great saphenous vein, should usually have bypass surgery first. This is because that saphenous vein bypass surgery has long-term patency results and associates with significant improved amputation free survival. The rate of balloon angioplasty failure is high, and results of bypass surgery after failed balloon angioplasty are significantly worse than for primary bypass surgery. However, patients with short life expectancy ( as those who are old aged with multiple comorbidities such as cardiovascular diseases) and those without a useable vein, should usually have balloon angioplasty first because they will not survive to reap the longer-term benefits of surgery.