Reporting Peripheral Artery Disease in Claudicants: Lessons Learned From the TASC-Ability Study.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• The Trans-Atlantic Inter-Society Consensus Document II (TASC II) is a widely used guide for classifying aortoiliac and femoropopliteal arterial lesions.
• It aims to guide treatment decisions by describing lesion severity and suggesting endovascular or surgical approaches.

Purpose of the Study:

• To evaluate the effectiveness and reliability of the revised TASC II classification system.
• To assess its performance in a large patient cohort presenting with intermittent claudication.

Main Methods:

• A retrospective review of arteriograms from 1454 patients with intermittent claudication.
• Classification of aortoiliac and femoropopliteal lesions using the TASC II criteria.
• Lesions where consensus could not be reached were categorized as 'unTASCable'.

Main Results:

• 20% of all lesions (n=493) and 26.7% of patients (n=388) had at least one unTASCable lesion.
• Common femoral artery involvement (53.1%) was the most frequent reason for lesions being unTASCable.
• Interobserver agreement was high for anatomical description (0.97) but lower for TASC II classification (0.85), particularly for aortoiliac lesions (0.69).

Conclusions:

• The revised TASC II system identified a significant proportion of lesions as unTASCable, highlighting limitations in current classification.
• Comprehensive anatomical descriptions of the infrarenal arterial tree demonstrated superior interobserver reproducibility compared to TASC II alone.
• Future efforts should focus on refining classification systems for peripheral artery disease to improve treatment planning and outcomes.