Complex Subintimal Superficial Femoral Artery Angioplasty and Stent
To treat a complex long occlusion (blockage) of the Superficial Femoral Artery
Background
A Superficial Femoral Artery (SFA) stent procedure is an intervention that aims to restore blood flow to the buttocks and the leg. This major artery carries blood to the whole of the leg and, therefore, blockage of this vessel can lead to serious complications whereby the leg may have to be amputated. Blockage is usually due to atherosclerosis, a process where cholesterol deposits within the artery wall, eventually leading to narrowing of the artery, and blockage of the blood flow. Narrowing of the vessel can cause symptoms such as pain in the calves on walking (intermittent claudication) – you have to stop after a similar distance and rest in order to be able to walk a similar distance again. Progression of the disease can then ultimately lead to the complete occlusion of the vessel (blockage), which can result in pain atrest and loss of tissue (ulcers) on the leg. The last stage of this condition is called critical limb ischaemia.
There are different options of treatment for patients with occluded superficial femoral artery – conservative and invasive.
Every patient should be started on antiplatelet medication and statins as a best medical therapy to reduce the progression of the diseasein the vessels. Also remaining active with regular exercise and trying to walk through the pain is the recommended approach.
Invasive procedures are for patients with critical limb ischaemia, which include:1. Endovascular treatment – angioplasty or stenting, which is what is described in this document.
2. Surgical treatment - bypass surgery. Recent meta-analysis of critical limb ischaemia treatment suggests that endovascular strategy should be reserved
For less fit patients with multiple comorbidities as the first line of treatment, and surgical options should be offered to the rest of patients as a first line of limb salvage treatment strategy. This document will focus on complex, long occlusions classified as greater than 5cm of blockage in the artery. Surgical revascularization (creating a new vessel to bypass the blockage) is usually preferred for long-segment disease, with stenting reserved for patients with limb-threatening ischemia and no surgical alternative.
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