Stenting Of The Superficial Femoral
Peripheral arterial disease (PAD) of the superficial femoral artery (SFA) is that the commonest explanation for lameness. Atherosclerotic disease of the SFA is localized to the region of Hunter’s canal. An isolated occlusion or
stenosis of the SFA often results in decreased perfusion of the leg, resulting in demand related, reversible, ischemic pain localized to the calf. Ischemic rest pain and tissue loss, also known as critical
limb ischemia (CLI), are uncommon manifestations of isolated SFA disease. CLI is more commonly observed when occlusive disease of the SFA is combined with occlusive disease involving the below knee popliteal artery or tibial arteries. Endovascular treatment of the SFA was first described by Charles Dotter in 1964. In Dotters original description, he used Teflon coated dilators to sequentially angioplasty the SFA in an 82-year-old woman to treat critical
limb ischemia that was considered non-operable. Subsequently, Gruntzig popularized the concept of catheter directed balloon angioplasty. Angioplasty disrupts the atherosclerotic plaque by displacing it radially. This action leads to stretching of the adventitia thereby increasing the lumen diameter within the treated vessel. By definition, a dissection is made and if significant, are often flow limiting. Currently, the most commonly utilized endovascular revascularization options are percutaneous transluminal angioplasty (PTA) with provisional stenting or primary stenting. Provisional or selective stenting is indicated for the treatment of flow limiting dissections and/or persistent, hemodynamically significant stenoses or recoil after PTA. This approach is recommended by the Tran-Atlantic inter-Society Consensus document II (TASC II) when treating SFA disease. However, both PTA alone and first stenting can successfully treat SFA disease. Therefore, the debate continues as to which endovascular treatment is superior.
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