Reply

Abstract

The letter by Hisato Takagi provides further interesting data on the role of endoluminal superficial femoral artery (SFA) interventions. Their analysis of the four randomized trials that are presently available in the literature confirms that percutaneous angioplasty alone remains the primary treatment for SFA disease, with stent placement being reserved for technical and procedurerelated complications. The recent data on drug-eluting stents, although suggesting a marginal benefit, have shown that changes in stent technology have not altered the balance between primary PTA and primary stenting. The analysis by Takagi et al is weakened by virtue of the fact that they were unable to categorize treated vessels by TransAtlantic Inter-Society Consensus (TASC) classification. This would significantly aid those pursuing SFA interventions. Our own data suggested that TASC A and B lesions performed satisfactorily to PTA, with secondary stenting as needed, and that C and D lesions do not perform as well as conventional bypass. We still pursue the belief that primary PTA for SFA disease remains the treatment of choice, with stents being used selectively.