Outcomes on Endovascular Treatment of Transatlantic Inter-society Consensus II D Femoropopliteal Lesions in Patients with Critical Limb Ischemia: Single-Center Study

Objectives: Although TransAtlantic Inter-Society Consensus II (TASC II) guidelines recommend open surgical repair for TASC II D femoropopliteal lesions, evolving endovascular techniques have made minimally invasive alternatives viable in selected cases. This study evaluates outcomes of endovascular interventions in patients with TASC II D femoropopliteal occlusive disease. Methods: A prospective analysis of 94 procedures was conducted from July 2023 to April 2024. Seventy-three cases involved superficial femoral artery (SFA) occlusions >20 cm, 12 involved popliteal/trifurcation occlusions, and 9 involved both. Statistical analysis included the Chi-square test and logistic regression to identify risk factors. Kaplan–Meier analysis assessed target lesion revascularization, limb salvage, and survival. A P < 0.05 was considered statistically significant. Results: The mean patient age was 54 ± 0.11 years; 74.4% were male. Comorbidities included hypertension (42.4%), diabetes (59.4%), smoking (65.1%), coronary artery disease (36.0%), and cardiac insufficiency (49.1%). All patients presented with chronic limb-threatening ischemia (Rutherford 5: 74.6%, Rutherford 6: 25.3%). The technical failure occurred in 7.4%. Selective stenting was performed in 28.7%. Limb salvage at 30 days, 6 months, and 1 year was 96.4%, 90.2%, and 85.9%, respectively. Re-intervention was required in 11.1%. Female sex, multilevel occlusion, distal SFA stenting across the adductor canal ( P = 0.029), and smoking were independent predictors of poorer outcomes. Conclusions: Endovascular treatment of TASC II D lesions demonstrates promising limb salvage rates, even in complex occlusions. However, outcomes are significantly influenced by anatomical complexity and patient risk factors. Multilevel disease, distal SFA stenting, female sex, and smoking are associated with higher risks of re-intervention and limb loss.