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From the Masters: A sea-change for TransAtlantic Inter-Society Consensus (TASC)

In 1996, a novel consensus process was initiated entitled: ‘the Management of Peripheral Arterial Disease – TransAtlantic Inter-Society Consensus’, which is well known in the vascular community as TASC.1 As noted in the Introduction to the Consensus, a key rationale was to address the observation that a ‘surprising variation continues to be found in the management of individual patients with identical conditions’, with the goal to ‘help promote a uniform high-level of medical care across different countries’. The members of the writing group were from the major vascular societies at the time, representing vascular surgery, cardiology, vascular medicine/angiology, interventional radiology, vascular pathology and health economics and outcomes. The committee was chaired by two wellknown and quite visionary vascular surgeons: John Dormandy from London and Robert Rutherford from Colorado. Bob was my mentor in medical school, where he enlisted me to do research in our vascular laboratory, and from that experience and Bob’s expansive personality, I knew I wanted to be a vascular physician. Then early in my career at the University of Colorado, I was very fortunate to represent the Society for Vascular Medicine (SVM) as a member of the TASC writing group. From that engagement, I embarked on a marvelous journey that opened my perspective to a broad international group of recognized leaders in their vascular disciplines. This group worked well together to run a disciplined writing committee that included input from the key vascular societies to develop a final document; the results published in the year 2000 generated 107 recommendations and 47 critical issues.1 Remarkably, all of these recommendations were agreed upon except for one footnote describing a TASC type B femoropopliteal lesion, where the Cardiovascular and Interventional Radiological Society of Europe had a slightly different definition. In addition to providing a comprehensive overview of all aspects of the diagnosis and management of peripheral artery disease (PAD), this first consensus established a morphologic lesion stratification for iliac, femoropopliteal, and infrapopliteal lesions that was intended to provide a classification system and to recommend appropriate treatment strategies with the main options of endovascular versus open surgical repair. At that time, these recommendations were based mostly on a consensus, not evidence, and followed the concept that a simple proximal stenosis could be approached with an endovascular procedure and more complex and distal disease would usually require a surgical bypass. Published in the year 2000, this guideline established many precedents. The writing committee was international (primarily Western Europe and North America) and represented the primary vascular disciplines, with a goal to harmonize efforts in order to provide the best care for the vascular patient. Subsequently, a number of key guidelines soon followed, including those from the American College of Cardiology/American Heart Association and additional guidelines from the various vascular subspecialties.2 Personally, working on TASC on behalf of the SVM was quite invigorating in that it opened up opportunities to establish new international relationships, to think rigorously, and to challenge my writing group peers to achieve a comprehensive and inclusive document. In addition, I valued the broader vision of bringing disparate societies together to improve patient care. After publishing TASC, John Dormandy wanted to step down, and Lars Norgren who represented the European From the Masters: A sea-change for TransAtlantic Inter-Society Consensus (TASC)