Lyden Sean P, Smouse H Bob
Desk S40 Vascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Endovasc Ther. 2009 Apr;16(2 Suppl 2):II5-18. doi: 10.1583/08-2659.1.
The stratifications of aortoiliac, femoropopliteal, and infrapopliteal lesions included in the original comprehensive report of the TransAtlantic Inter-Society Consensus (TASC I) have been commonly used to formally characterize clinical trial populations and to channel investigative discussion among clinicians, while the associated treatment recommendations have become outdated as compared to current clinical practice. The TASC II report is an abbreviated update focusing on key areas of diagnosis and management of peripheral artery disease, with revised stratifications of aortoiliac and femoropopliteal lesions but not infrapopliteal disease. The consensus document keeps new lesion stratifications linked to the same structure of recommendations for initial treatment: endovascular for type A, endovascular (with qualifications) for type B, open surgical (with qualifications) for type C, and open surgical for type D. In general, each TASC II lesion category includes more severe disease than in TASC I, but the TASC II report does not recommend specific endovascular modalities for infrainguinal occlusive disease. We discuss how the new TASC II femoropopliteal lesion categories reflect current research outcomes and clinical practice, including summarized results from some more recent studies that have demonstrated the ability to treat by endovascular means increasingly complex femoropopliteal lesions that would actually be classifiable as type C. Noting that TASC II does not include a separate stratification of infrapopliteal lesions, as did TASC I, we review evidence of recent endovascular treatment of infrapopliteal lesions and contend that TASC classifications in this anatomical area should be upgraded.
跨大西洋跨学会共识（TASC I）的原始综合报告中所包含的主髂动脉、股腘动脉和腘以下动脉病变的分层，一直被广泛用于正式描述临床试验人群，并引导临床医生之间的研究讨论，然而与当前临床实践相比，相关的治疗建议已经过时。TASC II报告是一份简短的更新，重点关注外周动脉疾病诊断和管理的关键领域，对主髂动脉和股腘动脉病变进行了修订分层，但未涉及腘以下动脉疾病。该共识文件将新的病变分层与初始治疗的相同推荐结构相关联：A型采用血管腔内治疗，B型采用血管腔内治疗（有条件），C型采用开放手术（有条件），D型采用开放手术。一般来说，与TASC I相比，每个TASC II病变类别都包含更严重的疾病，但TASC II报告并未推荐针对股腘以下闭塞性疾病的特定血管腔内治疗方式。我们讨论了新的TASC II股腘动脉病变类别如何反映当前的研究成果和临床实践，包括一些近期研究的总结结果，这些研究表明血管腔内治疗能够处理实际上可归类为C型的越来越复杂的股腘动脉病变。注意到TASC II不像TASC I那样对腘以下动脉病变进行单独分层，我们回顾了近期腘以下动脉病变血管腔内治疗的证据，并认为该解剖区域的TASC分类应该升级。
