Delphi Consensus Study Toward a Comprehensive Classification System for Angioplasty-Induced Femoropopliteal Dissection

被引:16
作者
Voute, Michiel T. [1 ]
Stathis, Alexandra [1 ]
Schneider, Peter A. [2 ]
Thomas, Shannon D. [1 ,3 ,4 ]
Brodmann, Marianne [5 ]
Armstrong, Ehrin J. [6 ]
Holden, Andrew [7 ]
Varcoe, Ramon L. [1 ,3 ,4 ]
机构
[1] Prince Wales Hosp, Dept Surg, Sydney, NSW, Australia
[2] Univ Calif San Francisco, San Francisco, CA 94143 USA
[3] Univ New South Wales, Fac Med, Sydney, NSW, Australia
[4] Prince Wales Hosp, Vasc Inst, Sydney, NSW, Australia
[5] Med Univ Graz, Dept Angiol, Graz, Austria
[6] Univ Colorado, Aurora, CO USA
[7] Auckland Hosp, Dept Intervent Radiol, Auckland, New Zealand
关键词
  angioplasty; dissection; femoropopliteal artery; peripheral artery disease; BALLOON ANGIOPLASTY; ANGIOGRAPHIC DISSECTION; STREPTOKINASE; OUTCOMES;
D O I
10.1016/j.jcin.2021.07.056
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The aim of this study was to seek expert consensus regarding the features that predict adverse outcomes in order to develop a dedicated angiographic classification system for femoropopliteal artery dissection. BACKGROUND Dissection of the femoral and popliteal arteries is common after percutaneous angioplasty. Its classi-fication is important. However, all current classification systems have significant limitations. METHODS Delphi consensus methodology was performed over 3 rounds, using an expert panel of 17 interventionalists. Each was asked to rank dissection features with the potential to lead to acute technical failure and/or early restenosis and then which combination of features would require the placement of a metallic scaffold to avoid those outcomes. Results were used to develop a novel grading system and dissection treatment algorithm. RESULTS Four main characteristics were identified from a comprehensive preliminary list. There was a good level of agreement between panelists from 773 responses (48 combinations). All panelists recommended scaffolding if a dissection produced a $50% diameter reduction (100%). Most recommended scaffolding if the dissection had a spiral shape (73%-100%), was severely flow limiting (93%-100%), or had complex morphology defined by long and multiple dissections (65%-100%). Multiple combinations of those features were more likely to receive a recommendation to scaffold. CONCLUSIONS Scaffolding of a postangioplasty dissection is recommended in the presence of significant diameter reduction, spiral shape, flow impairment, or adverse morphology (DISFORM). The DISFORM classification system has been developed as a tool to provide uniform language to standardize reporting and for discussion of dissection treatment and prognosis. (J Am Coll Cardiol Intv 2021;14:2391-2401) (c) 2021 by the American College of Cardiology Foundation.
引用
收藏
页码:2391 / 2401
页数:11
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