Patient Selection: Lesion Characteristics and Predictors of Outcome

Patient selection based on predictors of outcome and lesion characteristics has been a strong part of vascular surgeons performing endovascular peripheral arterial interventions. The TansAtlantic Inter-Society Consensus (TASC) has defined plaque morphology for iliac and femoropopliteal artery lesions. TASC also outlines other indicators of success including the indication of claudication, proximal lesion location, focal morphology, multivessel run-off, male gender, and no diagnosis of diabetes mellitus or renal failure. This information guides the vascular surgeon as to what lesions may be best treated by endovascular means. Furthermore, outcome of interventions has been linked to types of TASC lesions treated. Other factors, not specifically addressed by TASC may play a vital role in determining who may be at increased risk of failure and alter patient selection for an endovascular intervention. These include calcification load, risk of embolism, tortuosity, artery diameter, and proximity to other structures such aneurysms, side branches, or graft anastomoses. Refining patient selection can also be improved by review of predictors of endovascular complications. Herein, information is provided to improve patient selection based on lesion characteristics and predictors of outcome.