Abstract
A narrative review of the data provided by Randomised Controlled clinical trials and meta-analyses was undertaken to assess how much reliance a clinician could place on these in selecting a treatment for patients with disease of the Femoral artery. An attempt was made to detect and review every clinical trial and meta-analysis published on treatments relating to disease of the femoral artery but not relating to drug treatment. Disease of the femoral artery in >65 years age group occurs in approximately 20% of the population but symptomatology was present in 40%. In almost all trials the predominant (>90%) indication for treatment was intermittent claudication. In this setting, clinical benefit was limited and did not extend beyond 12 months. Mortality, from co-morbidities was high. The Basil Trial was the only one to examine intervention for critical limb ischemia. The results for Bypass surgery and Percutaneous transarterial balloon angioplasty (PTA) were equivalent. There is little evidence to support the use of PTA or stenting other than in the treatment of patients with critical limb ischemia.
Highlights
Atherosclerotic disease of the femoral Artery is a marker for the presence of systemic atherosclerotic disease
Intervention”, “treatment of atherosclerotic disease of the femoral artery by percutaneous balloon angioplasty (PTA) and stenting”, “drug eluting balloons (DEB) in Percutaneous transarterial balloon angioplasty (PTA) and drug eluting stents and the femoral artery” and cross referenced these with clinical trials and meta-analyses
The data extraction method used was by searching for keywords PTA, DEB, DES, balloon angioplasty, covered stent, standardized exercise programs and peripheral artery disease
Summary
Atherosclerotic disease of the femoral Artery is a marker for the presence of systemic atherosclerotic disease. Diehm C, Schuster A, Allenberg JR et al [1] reported on 6880, unselected patients, older than 65 years of age in the German Epidemiological Trial. In this cross-sectional study 344 general practitioners measured bilateral Doppler ultrasound ankle brachial systolic pressure Indices (ABSPI) bilaterally, recorded history, physical examination, and the WHO questionnaire on Claudication. Question arises as to when PAD in the femoral artery should be treated and what form should this treatment take It is clear from the quoted studies that the co-morbidities of hypertension, diabetes, lipid disorders and smoking should be addressed as baseline management of any patient with peripheral vascular disease
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