Update to TASC II Guidelines Addresses Below-the-Knee PAD

August 5, 2015—The International Society of Endovascular Specialists (ISES) announced the publication of the latest update of the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) guidelines for the management of patients with peripheral arterial disease (PAD) in the society’s Journal of Endovascular Therapy (JEVT, 2015;22:657-671). The document is an update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries. It is a supplement to TASC II guidelines first published in 2007.

The TASC II guideline update by the TASC Steering Committee is available online, along with a commentary by George A. Antoniou, et al titled, “TASC II Anatomic Classification for Infrapopliteal Arterial Disease: A Framework for Clinical Practice and Future Research,” published in JEVT (2015;22:672-674).

The TASC Steering Committee is composed of Michael R. Jaff, DO; Christopher J. White, MD; William R. Hiatt, MD; Prof. Gerry R. Fowkes, MBChB; Prof. John Dormandy, MD; Mahmood Razavi, MD; Jim Reekers, MD; and Lars Norgren, MD.

ISES advised that the TASC II supplement is being copublished in the following journals:Vascular Medicine; Catheterization and Cardiovascular Interventions; Annals of Vascular Diseases; Journal of the Japanese College of Angiology (Japanese translation); and Técnicas Endovasculares (Spanish translation).

According to ISES, the TASC document that was originally published in 2000 represents the collaboration of international vascular specialties involved in the treatment of PAD patients. One highly utilized aspect of the TASC guidelines is the TASC anatomic artery lesion classification (A–D), which characterizes the various patterns of disease and provides guidance on treatment decisions regarding the optimal revascularization strategy (endovascular vs surgical).

The 2007 TASC II guidelines included a revision of the original TASC classification for PAD, with a focus on the aortoiliac and femoropopliteal territories.

As noted by the ISES, since the publication of the TASC II document, a number of scientific publications and observational reports have documented the rapid adoption of endovascular therapy as a primary strategy for the treatment of symptomatic PAD. The overall result is that there has been an increase in the adoption of the endovascular-first strategy for even the most complex anatomies. This shift was not clearly reflected in TASC II.

In addition, the TASC II lesion classification did not include the infrapopliteal arteries, which was an important omission given today’s expanding technologies and techniques for catheter-based tibial and distal interventions for patients with critical limb ischemia.

Thus, the focus of the current TASC II supplement is to update the endovascular and surgical revascularization strategies and techniques for PAD and to expand the TASC lesion classification to include below-the-knee arteries. The document has been prepared in relationship with a number of vascular societies worldwide and has been endorsed by the ISES, stated the society.