Percutaneous intervention for femoropopliteal artery occlusive disease

Abstract

The femoropopliteal segment is the most common location of lower extremity peripheral arterial occlusive disease. Atherosclerotic lesions within the superficial femoral artery (SFA) tend to be long and diffuse, rending interventions more challenging, both in their approach and durability. Furthermore, the SFA and popliteal arteries are high-resistance and low-flow in character and subject to mechanical stresses from joint flexion, all variables that adversely affect long-term patency of any endovascular intervention. Once an endovascular approach has been deemed warranted, the set-up in terms of access, imaging, wire crossing, and intervention is critically important to achieve the optimal patient outcome. A hybrid operating endovascular suite provides the optimal resolution and field of view to accomplish these percutaneous interventions, but a mobile C-arm is satisfactory. Multiple anatomic classification systems can guide the decision-making process for intervention, the most common of which is the TransAtlantic Inter-Society Consensus (TASC) II classification.