Abstract
Endovascular procedures for the management of the superficial femoral (SFA) and popliteal artery disease are increasingly common. Over the past decade, several stent technologies have been established which may offer new options for improved clinical outcomes. This paper reviews the current evidence for SFA and popliteal artery angioplasty and stenting, with a focus on randomized trials and registries of nitinol self-expanding stents, drug-eluting stents, dug-coated balloons, and covered stent-grafts. We also highlight the limitations of the currently available data and the future routes in peripheral arterial disease (PAD) stent and balloon technology.
Highlights
Peripheral arterial disease (PAD) of the lower extremities remains one of the often unrecognized manifestations of systemic arteriosclerosis symptomatically affecting between 3% and 7% of the population and up to one in five patients older than 75 years of age [1]
Old generation balloon-expandable metal stents are no longer used in the femoropopliteal segment as they are susceptible to external compression and longitudinal axis deformation related to restenosis
Since a rapidly increasing number of patients with superficial femoral (SFA) and popliteal artery disease have been treated by stent implantation in the last few years, we are confronted with more and more patients presenting with in-stent restenosis (ISR), which is mainly caused by endogenic factors
Summary
Peripheral arterial disease (PAD) of the lower extremities remains one of the often unrecognized manifestations of systemic arteriosclerosis symptomatically affecting between 3% and 7% of the population and up to one in five patients older than 75 years of age [1]. It has a major harmful impact on quality of life and is an underrecognized marker of multisystem vascular disease. PAD is usually multilevel and femoropopliteal lesions may be combined either with inflow aortoiliac disease usually in middle-aged smokers or with distal infrapopliteal outflow lesions usually in patients presenting with limb-threatening CLI. Percutaneous intervention (angioplasty and/or stenting) is the suggested treatment of choice in the majority of patients with IC or CLI on the basis of its reduced perioperative morbidity and mortality and reduced in-hospital stay, whereas its long-term outcomes are comparable to bypass surgery [8, 9]
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