Assessment of the Endovascular Management of Flush Superficial Femoral Artery (SFA) Total Occlusion

Abstract

Background: Involvement of the superficial femoral artery (SFA) in occlusive peripheral arterial disease (PAD) is extremely common representing 80% of the symptomatic patients undergoing angiography. Objectives: This study aimed to assess the endovascular management of flush SFA total occlusion in patients with PAD and with critical chronic lower limb ischemia due to flush occlusion of the SFA in the Vascular Surgery Department in Al-Azhar University Hospitals. Patients and Methods: Patients with chronic PAD and aged 40–65 years, with SFA flush total occlusion including heavily calcified, long, and fibrotic lesions, and the occlusions up to 15 cm long in the SFA were included in the current study. Patients were subjected either to contralateral approach, ipsilateral antegrade approach, ipsilateral horizontal puncture, or retrograde access to the SFA via popliteal or dorsalis pedis. Results: An overall 20 patients were enrolled in the current study with a mean age of 59.5± 6.77 years. There were 55% females and 45% males. The risk factors distribution among the studied group were diabetes mellitus (100%), hypertension (65%), smoking (65%), chronic hepatic disease (65%), dyslipidemia (55%), and only 5% had chronic vascular disease. Patients were clinically presented by toe gangrene (35%), followed by foot gangrene (25%), as the main presentation. Conclusion: Endovascular management strategies of flush SFA total occlusion in patients with PAD due to SFA total occlusion can be safely used with acceptable technical success, short term patency rates, and limb salvage.