Endovascular interventions to superficial femoral artery occlusion: Different approaches, technique, and follow-up

Abstract

Background: Superficial femoral artery lesion is one of the main causes for intermittent claudication or critical limb ischemia. Percutaneous transluminal angioplasty is one of the approved therapies for this medical entity. Anatomical factors should be considered in choosing the right approach and puncture. The purpose of this study is to discuss the anatomical, radiological, and technical factors which determine the preference of various approaches and to determine its safety, efficacy, and mid-term clinical and radiological outcome. Methods: Retrospectively, data were collected from patients who underwent angioplasty to superficial femoral arteries for total occlusion from January 2015 and June 2018 in our center, we performed angioplasty to 59 occluded superficial femoral artery patients at our center. The ipsilateral femoral artery, ipsilateral popliteal artery, contralateral femoral artery, or upper limb approaches were used depending on the various anatomical factors determined by radiological imaging before the procedure. Results: Acute success rate was 91.52%. There were no significant periprocedural complications. At the latest clinical follow-up of mean 25.8 months (10–51), a restenosis rate of 16.67% in infrainguinal arteries and 5.88% in suprainguinal arteries were noted. Conclusions: Percutaneous transluminal angioplasty of superficial femoral artery is a proven, viable, safer, and effective option, with good mid-term clinical results and patency rates. Different approaches to be chosen depends on the anatomical and technical factors to get the best possible outcome.

Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review and Meta-Analysis

“…High technical success rates were observed in both groups. In the ET group, 17 studies [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] reported technical success. An overall success rate of 92.52% (95% CI [89.08%, 94.94%]) was noted ( Figure 2 A).…”

“…The subsequent need for surgery was reported in a few cases of ET. 10 studies [ 6 , 8 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 20 ] reported a need for further surgical interventions. Overall, 3.21% (95% CI [1.90%, 5.36%]) ( Figure 3 ) of the cases required conversion to open surgery.…”

“…Symptom improvement was reported in 9 case series [ 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] for ET procedures, while under FAE treatment, 1 RCT [ 6 ] and 5 case series [ 5 , 23 , 24 , 25 , 26 ] commented on symptom improvement. For ET procedures, the overall rate of symptom improvement was 83.10% (95% CI [73.67%, 89.63%]) ( Figure 4 A).…”

“…The need for revascularisation was considered to be low in both procedures. In the ET group, 16 studies [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 27 ] reported this, with an overall rate of 13.03% (95% CI [8.5%, 19.47%]) ( Figure 5 A). In the case of FAE, seven studies [ 5 , 6 , 22 , 23 , 24 , 25 , 26 ] discussed the need for revascularisation, with an overall rate of 10.11% (95% CI [6.59%, 15.19%]) ( Figure 5 B).…”

“…There was a low incidence of amputation for both treatment options discussed. In the ET group, 15 studies [ 6 , 7 , 8 , 10 , 11 , 12 , 14 , 15 , 16 , 18 , 19 , 20 , 21 , 22 , 27 ] discussed the incidence of amputation. Amongst these studies, a total of 2.44% (95% CI [1.38%, 4.25%]) ( Figure 6 A) of the patients underwent amputation.…”