SCAI expert consensus statement for femoral‐popliteal arterial intervention appropriate use

Abstract

Successful endovascular intervention for femoral-popliteal (FP) arterial disease provides relief of claudication and offers limb-salvage in cases of critical limb ischemia. Technologies and operator technique have evolved to the point where we may now provide effective endovascular therapy for a spectrum of lesions, patients, and clinical scenarios. Endovascular treatment of this segment offers a significant alternative to surgical revascularization, and may confer improved safety for a wide range of patients, not solely those deemed high surgical risk. Although endovascular therapy of the FP segment has historically been hampered by high rates of restenosis, emerging technologies including drug-eluting stents, drug-coated balloons, and perhaps bioabsorbable stent platforms, provide future hope for more durable patency in complex disease. By combining lessons learned from clinical trials, international trends in clinical practice, and insights regarding emerging technologies, we may appropriately tailor our application of endovascular therapy to provide optimal care to our patients. This document was developed to guide physicians in the clinical decision-making related to the contemporary application of endovascular intervention among patients with FP arterial disease. V C 2014 Wiley Periodicals, Inc.

SCAI appropriate use criteria for peripheral arterial interventions: An update

“…The severity and clinical impact of a lesion is also affected by its length, reference vessel diameter, arterial calcification, and quantity of atherosclerotic plaque (plaque burden). At this time, there are no published data regarding the use of translesional pressure gradients to assess the severity of femoral‐popliteal PAD .…”

“…In 2014, the Society for Cardiovascular Angiography and Interventions (SCAI) published the first Appropriate Use Criteria (AUC) for endovascular therapy (EVT) for atherosclerotic peripheral artery disease (PAD) involving the aorto‐iliac, femoral‐popliteal, infra‐popliteal, and renal arterial circulations . These documents were developed to assist clinicians' decision‐making, to improve patients' understanding regarding relative risks and benefits of a procedure, and to guide future research.…”

Management of Critical Limb Ischemia

“…For example, PAD patients who stop smoking have fewer cardiovascular events than those who continue smoking 69, 70 . Antiplatelet therapy with aspirin 71, 72 or clopidogrel 73 , and angiotensin converting enzyme inhibitors 74 decrease cardiovascular events in patients with PAD. Intensive statin therapy consistently lowers cardiovascular events in PAD patients compared to no statin or low intensity statins 75–77 .…”

Drug-Eluting Stents Are the Default Strategy for Superficial Femoral Artery Intervention Now

“…Most clinical results are derived from registries. 37,41,42 A 58-patient RCT of directional atherectomy to PTA in lower extremity PVD showed no difference in initial procedural success or target lesion revascularization (TlR); however, there was significantly more distal embolization with atherectomy. 43 Concern about distal embolization of atheromatous debris has prompted the use of embolic protection devices, 44 and their Food and Drug Administration clearance for use in this setting.…”

“…Adding the expense of a protection device to the already substantial price of an atherectomy catheter puts equipment cost in the range of $5000, in excess of virtually every other percutaneous strategy. 42 Despite this excessive cost, data supporting superior outcomes are lacking. For example, Marmagkiolis compared 12-month PP in 6024 patients with FP disease treated with 7 different types of endovascular devices.…”