Superficial Femoral Artery Stenting Research Articles

Standards of practice for superficial femoral and popliteal artery angioplasty and stenting.

This is a Standards of Practice document endorsed by CIRSE. The authors performed a literature review and provide recommendations and quality improvement guidelines based on the most recent and highest level of evidence available to date on the field of Superficial Femoral and Popliteal Artery Angioplasty and Stenting. Standards for the use of basic and more advanced endovascular techniques in the femoropopliteal arteries are reported and relevant aspects of case selection, imaging, follow-up, and overall patient management are presented to guide endovascular practice in Europe.

Serial optical coherence tomography assessments at 2- and 4-month follow-up after paclitaxel-eluting stenting of the superficial femoral artery

A 71-year-old man underwent endovascular therapy (EVT) with a paclitaxel-eluting stent in superficial femoral artery (SFA). Optical coherence tomography (OCT) of SFA at 2 months after EVT revealed that several struts were not covered with neointima. Moreover, some mural thrombi were detected within the stent. Although OCT revealed that the frequency of stent strut coverage was improved at the 4-month follow-up, uncovered stent strut still remained and some mural thrombi were observed within the stent even at 4 months after EVT. This is the first report to demonstrate the vascular response after paclitaxel-eluting stent placement for the lesion using serial OCT examinations.

Safety and efficacy metrics for primary nitinol stenting in femoropopliteal occlusive disease: A meta‐analysis and critical examination of current methodologies

The efficacy and safety of primary stenting for superficial femoral artery (SFA) disease have been benchmarked against historically derived performance goals. However, contemporary evidence evaluating SFA stenting is accumulating. The objective of this systematic review and meta-analysis was to quantitatively assess outcomes after primary SFA stenting with nitinol stents in contemporary practice, to compare these rates with commonly used efficacy and safety goals, and to discuss the clinical and regulatory implications of these findings. We searched MEDLINE, the US Food and Drug Administration (FDA) website, reference lists of qualifying articles, and conference proceedings until October 2012. Studies prospectively assessing primary nitinol stenting for diseased SFA were sought. Data from 11 prospective clinical trials were included. The twelve-month primary patency (PP) rate was reported in five trials. The meta-analytic 12-month PP rate was 71.6% (95% confidence interval [CI] 66.4-76.7%). The meta-analytic rate of 30-day freedom from a composite of death, target limb amputation, and reintervention was 99.9% (95% CI 100.0-90.0%). Contemporary nitinol-based bare-metal stents performed well in controlled settings. Occurrence of the 1-month composite safety endpoint was extremely uncommon.

Wall shear stress in the stented superficial femoral artery in peripheral arterial disease

ObjectiveLocal changes in wall shear stress (WSS) contribute to vascular wall thickening and subsequent stenosis. Restenosis after stenting is a major concern, especially in the superficial femoral artery (SFA) of patients with peripheral arterial disease (PAD). Local alterations in WSS after stenting might contribute to restenosis/reocclusion. To test the hypothesis that WSS is impaired along the stented SFA segment, we studied the profile of WSS along the femoro-popliteal axis after stent placement in a cross-sectional design. MethodsEighty-seven patients with PAD (89 limbs) were included one day after stenting of the SFA. Flow velocities (peak and mean) and vessel diameter were measured by duplex ultrasound in five predefined segments along the femoro-popliteal axis, at rest and after exercise (30 toe raises); WSS (peak and mean) was calculated from flow velocities, vessel diameter and whole blood viscosity. ResultsWSS progressively declined along the stented segment at rest (peak WSS, p < 0.0001; mean WSS, p < 0.05); after exercise, WSS increased in all segments (all p < 0.001), but, again, progressively declined along the stent (peak WSS, p < 0.0001; mean WSS, p < 0.05). The internal vessel diameter remained unchanged after exercise in the stented and in the non-stented parts of the femoro-popliteal axis (all p > 0.05). ConclusionIn PAD patients with SFA stenting WSS is impaired along the femoro-popliteal axis. The consequences of this finding in terms of local effects on the vessel wall that might favor restenosis/reocclusion needs further investigation.

Impact of changing PSVR thresholds on the patency rates of SFA recanalisation with self-expanding nitinol stents

The primary patency of superficial femoral artery (SFA) stents is evaluated by measuring PSVR. However, each trial uses a different definition of PSVR. We investigated the impact of changing PSVR thresholds on the patency rates of SFA recanalisation with self-expanding nitinol stents. A single-centre retrospective study was conducted. Between 2003 and 2006, 76 consecutive patients (83 limbs) were treated using nitinol self-expanding stents for SFA disease. Primary patency was defined as categories 1 (PSVR <2.0), 2 (PSVR <2.4) and 3 (PSVR <2.85). The mean follow-up time was 51±27 months. For one, five, and seven years, Kaplan-Meier estimates for primary patency rates were 62.6%, 36.8%, and 27.6%, respectively, in category 1; 75.2%, 46.5%, and 37.1%, respectively, in 2; and 75.2%, 46.1%, and 46.1%, respectively, in 3. The primary patency between categories 1 and 3 (p=0.038) was significantly different. No difference was observed between categories 2 and 3 (p=0.786), and a trend for differences was observed between categories 1 and 2 (p=0.069). PSVR definition may influence the reported long-term patency rate of a SFA stent. We should consider the definition of restenosis in each trial.

Treatment of Chronic SFA In-Stent Occlusion With Combined Laser Atherectomy and Drug-Eluting Balloon Angioplasty in Patients With Critical Limb Ischemia: A Single-Center, Prospective, Randomized Study

To compare the safety and efficacy of laser debulking (LD) and drug-eluting balloon (DEB) angioplasty to treatment with DEB angioplasty alone in patients affected by critical limb ischemia (CLI) and superficial femoral artery (SFA) chronic stent occlusion in a prospective, randomized study. Among 448 CLI patients treated from December 2009 to March 2011, 48 patients (39 men; mean age 72.7±7.8 years) with chronic SFA in-stent occlusion were randomly assigned to treatment using LD+DEB (n=24) or DEB angioplasty alone (n=24). Patency at 12 months was the primary outcome measure; secondary outcomes were target lesion revascularization (TLR) and clinical success at 12 months. In the LD+DEB group, the patency rates at 6 and 12 months (91.7% and 66.7%, respectively) were significantly higher (p=0.01) than in the DEB only patients (58.3% and 37.5%, respectively). TLR at 12 months was 16.7% in the LD+DEB group and 50% in the DEB only group (p=0.01). Two (8%) patients needed major amputations in the LD+DEB group vs. 11 (46%) in the DEB only group at 12 months (p=0.003). In this small initial experience, combined treatment with LD and DEB angioplasty is correlated with better outcomes in CLI patients with occluded SFA stents.

Post-operative Staphylococcus aureus infection of a superficial femoral artery stent

Post-operative Staphylococcus aureus infection of a superficial femoral artery stent

The breakage of a drug-eluting stent delivery system leading to limb amputation

A 68-year-old female with total occlusion of the bare metal stent in the left superficial femoral artery was treated by placement of three drug-eluting stents (DESs). Acute thrombosis developed on the next day. Thrombosis in the left popliteal artery to anterior tibial artery was found. An additional stent was placed in the popliteal artery. Rethrombosis was observed. The left leg could not be salvaged. Examination of the amputated limb revealed broken DES delivery system below the knee vessel. This was an unusual case of breakage of a DES delivery system that led to major amputation.

Deployment of self‐expandable stents for complex proximal superficial femoral artery lesions involving the femoral bifurcation with or without jailed deep femoral artery

To (1) compare the outcome of self-expandable stents with versus without jailed deep femoral artery (DFA) for proximal superficial femoral artery (SFA) lesions, and to (2) ascertain the fate of jailed DFA. Complex SFA lesions involving the femoral bifurcation (FB) was mostly treated surgically, and the role played by endovascular procedures is uncertain. We retrospectively identified 104 consecutive, de novo lesions involving the SFA ostium, stented between April 2005 and September 2010. Depending on the proximal stent edge location, the sample was divided between 60 distal common femoral artery (CFA) stenting with jailed DFA and 44 ostial SFA stenting without jailed DFA. The FB was the segment beginning in the distal CFA, 10 mm proximal to the DFA ostium and ending in the SFA and 10 mm distal to the carina. Stented CFA lesions proximal to the FB were excluded. The bifurcation was classified as patent when free of restenosis and repeat revascularization. The overall 12-month bifurcation and primary patency rates were 72.5% and 52.0%, respectively. Predictors of loss of bifurcation patency were ostial SFA stenting and a small stent in the FB. Bifurcation patency (83.3% vs. 56.3%; P < 0.01) and primary patency of the SFA (56.2% vs. 37.5%; P = 0.088) were higher after distal CFA than after ostial SFA stenting. In 95.7% of distal CFA and 100% of ostial SFA stenting, DFA remained patent at 12-month follow-up (P = 0.237). The 12-month fate of jailed DFA after distal CFA stenting was acceptable, and the bifurcation patency rate was higher than after ostial SFA stenting.

Multimodality Imaging of Lower Extremity Peripheral Arterial Disease

Patients with symptomatic peripheral arterial disease (PAD) affecting the lower extremities are initially evaluated with an ankle-brachial index (ABI) and segmental pressure measurements. An ABI 50% stenosis) with a sensitivity and specificity of 79% and 96%, respectively.1 An ABI between 0.90 and 1.0 is considered borderline. The localization of the stenosis can be inferred by an abnormal decrease (>20 mm Hg) in segmental lower extremity pressures. In the presence of calcified atherosclerosis, arteries may become stiff and noncompressible, which results in a falsely elevated ABI (often >1.3). For patients with suspected PAD and a normal ABI at rest, it is valuable to obtain postexercise ABI measurements, which if <0.85 are consistent with PAD and is an independent predictor of mortality.2 Imaging is then needed to confirm the location and degree of stenosis before revascularization or if the diagnosis of PAD is uncertain. Characterization of PAD can be performed with noninvasive angiography using computed tomography (CTA) or magnetic resonance angiography (MRA), as well as with duplex ultrasonography (US), depending on patient specific characteristics (Table 1). Advances in both CTA and MRA provide clinicians with the opportunity to obtain a high resolution, 3-dimensional (3-D) road map of the peripheral arterial tree in patients, particularly when planning revascularization strategies. Invasive digital subtraction angiography (DSA) has been the accepted standard for evaluation of lower extremity atherosclerosis. Although DSA is a robust technique for diagnosing significant arterial stenosis or obstruction, it provides a 2-D view of the vessels, which may underestimate the degree of stenosis for tortuous vessels.3 Furthermore, there are inherent risks with arterial access, ionizing radiation, and the use of iodinated contrast media (CM).4 View this table: Table 1. Comparison Between CTA, MRA, and Duplex US for Diagnosis of PAD This review aims to deliver a comprehensive, yet concise …

A Budget Impact Model for Paclitaxel-eluting Stent in Femoropopliteal Disease in France

PurposeThe Zilver PTX drug-eluting stent (Cook Ireland Ltd., Limerick, Ireland) represents an advance in endovascular treatments for atherosclerotic superficial femoral artery (SFA) disease. Clinical data demonstrate improved clinical outcomes compared to bare-metal stents (BMS). This analysis assessed the likely impact on the French public health care budget of introducing reimbursement for the Zilver PTX stent.MethodsA model was developed in Microsoft Excel to estimate the impact of a progressive transition from BMS to Zilver PTX over a 5-year horizon. The number of patients undergoing SFA stenting was estimated on the basis of hospital episode data. The analysis from the payer perspective used French reimbursement tariffs. Target lesion revascularization (TLR) after primary stent placement was the primary outcome. TLR rates were based on 2-year data from the Zilver PTX single-arm study (6 and 9 %) and BMS rates reported in the literature (average 16 and 22 %) and extrapolated to 5 years. Net budget impact was expressed as the difference in total costs (primary stenting and reinterventions) for a scenario where BMS is progressively replaced by Zilver PTX compared to a scenario of BMS only.ResultsThe model estimated a net cumulative 5-year budget reduction of €6,807,202 for a projected population of 82,316 patients (21,361 receiving Zilver PTX). Base case results were confirmed in sensitivity analyses.ConclusionAdoption of Zilver PTX could lead to important savings for the French public health care payer. Despite higher initial reimbursement for the Zilver PTX stent, fewer expected SFA reinterventions after the primary stenting procedure result in net savings.

TCT-181 Totally Occluded In-stent Restenosis After Superficial Femoral Artery Stenting does not Worsen the Long-term Outcomes, but tend to Recur Occlusively

TCT-181 Totally Occluded In-stent Restenosis After Superficial Femoral Artery Stenting does not Worsen the Long-term Outcomes, but tend to Recur Occlusively

In vitro stent lumen visualisation of various common and newly developed femoral artery stents using MR angiography at 1.5 and 3 tesla

To evaluate stent lumen assessment of various commonly used and newly developed stents for the superficial femoral artery (SFA) using MR angiography (MRA) at 1.5 and 3 T. Eleven nitinol stents and one cobalt-chromium stent were compared regarding stent lumen visualisation using a common three-dimensional MRA sequence. Maximum visible stent lumen width and contrast ratio were analysed in three representative slices for each stent type. A scoring system for lumen visualisation was applied. Nitinol stents showed significantly better performance than the cobalt chromium stent (P < 0.05) at 1.5 and 3 T. Maximum visible stent lumen ranged between 43.4 and 95.5 %, contrast ratio between 7.2 and 110.6 %. Regarding both field strengths, seven of the nitinol stents were classified as "suitable". Three nitinol stents were "limited", and one nitinol stent and the cobalt chromium stent were "not suitable". Intraluminal loss of signal and artefacts of most of the SFA stents do not markedly limit assessment of stent lumen by MRA at 1.5 and 3 T. MRA can thus be considered a valid technique for detection of relevant in-stent restenosis. Applied field strength does not strongly influence stent lumen assessment in general, but proper choice of field strength might be helpful.

Twelve-month Results of the EverFlex Stent in the Superficial Femoral Artery

PurposeTo evaluate the clinical efficacy of EverFlex stents (length, 6–20 cm) for the treatment of peripheral artery disease (PAD) in the superficial femoral artery (SFA). Material and MethodsOver a period of 18 months, 56 SFA lesions in 53 patients were treated with an EverFlex stent. The following parameters were documented before the intervention, immediately afterward, and 12 months later: clinical stage, ankle-brachial index, and peak systolic velocity ratio (PSVR). The primary study endpoint was the primary patency rate after 12 months (defined as a PSVR < 2.5). ResultsIn 18% of the 56 lesions, complete occlusions were present. Mean lesion length was 9.4 cm ± 5.3, and mean stent length was 12.6 cm ± 5.6. Of the 53 patients enrolled in the study, a 12-month follow-up was performed in 46. The primary patency rate after 12 months was 71.7%. In-stent restenosis or occlusion occurred in 13 patients. Compared with the total study group, the mean stent length in these 13 patients was greater (14.0 cm ± 7.3) and the incidence of de novo lesions was lower. In the patient group with stents less than 10 cm in length (n = 24), six patients (25%) required a repeat intervention, compared with seven patients (32%) in the group with stents longer than 12 cm. ConclusionsAlthough the primary patency rate associated with the EverFlex stent is comparable to those in published data, the present results demonstrate a higher percentage of in-stent stenoses in patients in whom longer SFA stents were implanted.

Invited commentary

The utilization of lower extremity endovascular interventions for the treatment of both claudication and critical limb ischemia has dramatically increased in the last decade. Part of this increase may be accounted for because of technological advances and part may be due to more aggressive treatment of patients considered high medical risk who would have previously been precluded from more traditional open bypass procedures. Dr Al-Nouri and colleagues have provided a detailed analysis of their institutional experience with endovascular interventions in the superficial femoral artery. Despite the small size of the study group and the cohort heterogeneity, their results have produced some important treatment options and essential patient messages that can be used by the peripheral interventionalist. First, patients with critical limb ischemia (CLI) by definition generally represent a group of persons with a heavier burden of atherosclerotic disease. As a result, these unfortunate patients also have more concomitant comorbidities than persons with claudication alone. Taking steps to reduce perioperative risk such as maximizing atherosclerotic risk factor management medically, using local or regional anesthetic modalities, employing advanced wound care techniques, or even discussing observation or primary amputation alone are all fundamental to patient care and communication. Thus, management of CLI requires a multidisciplinary team approach and detailed patient communication and understanding of the possible negative outcomes. Conversely, claudicants tend to have less diffuse peripheral vascular disease, better tibial runoff vessels, and also in many situations, better functional outcomes. Even though failed superficial femoral artery (SFA) interventions in patients with lifestyle-limiting claudication (especially TransAtlantic Inter-Society [TASC] C and D compared with A and B lesions) may not necessarily lead to amputation or bypass, the authors recommend primary bypass in those with adequate autogenous conduit. Second, both a clear assessment of the extent of lower extremity atherosclerotic disease and an extensive armamentarium of potential interventions are keys to success. In Dr Al-Nouri's series, 36% of the patients had claudication alone, whereas the other 64% had either rest pain or tissue loss. While an isolated intervention in the SFA may be adequate for improved flow in a claudicant, a person with CLI needs restoration of in-line, pulsatile flow to heal a wound or alleviate rest pain. As these patients have more diffuse disease with multiple arterial segments involved, a combination of interventions may be necessary. In cases with poor tibial runoff or a heavily diseased SFA, failure rates of isolated SFA interventions will be higher. It is not surprising that this study demonstrated that interventions performed in CLI patients with more advanced TASC C and D lesions were more likely to fail and need either bypass or amputation. With more advanced SFA disease, these patients probably had coexisting tibial disease and more heavily calcified vessels. It would be interesting to see Dr Al-Nouri's results in the treatment of multisegment disease in patients with CLI. Nonetheless, Dr Al-Nouri and colleagues had a 40% and 46% secondary patency rate for TASC C and D lesion interventions, respectively, and a 93% overall limb salvage rate. They conclude that in patients with claudication and advanced lesions, perhaps open bypass should be the treatment of choice. However, in patients with CLI, an aggressive approach to limb salvage, whether open or endovascular based upon medical risk, may be a justifiable and acceptable suggestion to primary amputation. Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvageJournal of Vascular SurgeryVol. 56Issue 1PreviewEndovascular treatment of superficial femoral artery (SFA) lesions is a well-established practice. The repercussions of failed SFA interventions are unclear. Our goal was to review the efficacy of SFA stenting and define negative effects of its failure. Full-Text PDF Open Archive

Duplex Evaluation Following Femoropopliteal Angioplasty and Stenting: Criteria and Utility of Surveillance

Surveillance following lower extremity bypass, carotid endarterectomy, and endovascular aortic aneurysm repair has become the standard of care at most institutions. Conversely, surveillance following lower extremity endovascular interventions is performed somewhat sporadically in part because the duplex criteria for recurrent stenoses have been ill defined. It appears that duplex surveillance after peripheral endovascular interventions, as with conventional bypass, is beneficial in identifying recurrent lesions which may preclude failure and occlusion. In-stent stenosis following superficial femoral artery angioplasty and stenting can be predicted by both peak systolic velocity and velocity ratio data as measured by duplex ultrasound. Duplex criteria have been defined to determine both ≥50% in-stent stenosis and ≥80% in-stent stenosis. Although not yet well studied, it appears that applying these criteria during routine surveillance may assist in preventing failure of endovascular interventions.

Investigating the value of a surveillance scan of the superficial femoral artery at one year post-bare metal stent insertion

Introduction Placing a bare metal stent within the superficial femoral artery (SFA) can prolong vessel patency when compared with balloon angioplasty alone. Subsequent in-stent re-stenosis does occur in some individuals. In our institution, a surveillance programme to identify and treat ‘clinically silent’ stenoses has been running for two years and the purpose of this study was to evaluate this programme. Methods Retrospective review of cases was performed making note of indication for stenting, initial clinical outcome and the results of follow-up diagnostic and interventional radiological procedures. Results In total, 41 patients were included in the study. The majority (76%) had a good clinical outcome maintained during the first year at which stage a surveillance ultrasound was performed. Sixteen of these showed no evidence of significant in-stent stenosis or occlusion. Eleven of the remainder had ‘clinically silent’ in-stent stenosis. Nine of these had successful in-stent angioplasty. Ten (24%) patients became symptomatic within the first year. Ultrasound in seven of these patients revealed two in-stent occlusions, one in-stent re-stenosis and four with no significant findings. One patient went straight to have angiography, revealing in-stent re-stenosis. Conclusion Our surveillance programme has successfully identified and treated clinically silent in-stent stenoses in 22% of patients with an SFA stent who may have progressed to symptomatic stenosis or occlusion. Our results highlight the importance of ultrasound surveillance following stent placement. Based on only one asymptomatic patient experiencing stent occlusion at one year, and symptomatic stent problems occurring anywhere from six to 193 days, we consider that one year surveillance is acceptable.

Combined common femoral artery endarterectomy with superficial femoral artery stenting plus Shuxuening Injection (舒血宁注射液) infusion for chronic lower extremity ischemia: 3-year results

To investigate the efficacy and safety of combined common femoral artery (CFA) endarterectomy with superficial femoral artery (SFA) stenting plus Shuxuening Injection infusion in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities. From March 2006 to March 2011, 104 lower limbs in 96 patients with multilevel peripheral arterial steno-occlusive disease, involving SFA as well as CFA and deep femoral artery (DFA) orifice, were treated by combined surgical with endovascular therapy, such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein. Before the end of the operation, 20 mL of Shuxuening Injection was infused through the catheter located in the treated artery. Technical and hemodynamic success, as well as primary and primary-assisted patency, was determined according to the Society for Vascular Surgery Guidelines. During follow-up, clinical status assessment, ankle-brachial index (ABI) test, and duplex Doppler ultrasound were administered every 6 months, and computed tomography angiography or magnetic resonance angiography was performed at 12, 24, and 36 months after discharge. All patients underwent successful combined CFA endarterectomy with SFA stenting treatment. The average ABI after the combination treatment increased from pretreatment of 0.32±0.21 to 0.82±0.24 (P<0.01). No perioperative death and major limb amputations occurred. The mean duration of follow-up for 104 limbs from 96 patients was 1,180 days (range, 196-2,064 days). During follow-up, 5 patients died due to myocardial infarction, cerebral infarction, or pneumonia, and 5 patients were lost to follow-up. There were 21 cases (21.4%) of restenosis, with 15 that occurred in-stent and 6 near the distal end of the stent. A total of 18 (18.3%) reinterventions were performed, including 6 balloon angioplasty, 8 restenting procedures, 2 bypass surgeries, and 2 major limb amputations. The primary patency rates were 92.2%, 76.8%, and 61.3% at 12, 24, and 36 months, respectively, while the primary-assisted patency rates were 94.4%, 83.2%, and 75.6% at 12, 24, and 36 months, respectively. The combined CFA endarterectomy with SFA stenting plus Shuxuening Injection infusion appears to offer a safe, less invasive, and effective treatment option to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease.

Stent Puncture for Recanalization of Occluded Superficial Femoral Artery Stents

To describe a technique to recanalize occluded superficial femoral artery (SFA) stents without inflow or outflow in patients with proximal SFA obstruction. After a failed attempt to engage an occluded stent through an antegrade femoral approach, a distal retrograde puncture of the proximal part of the stent was performed. After subintimal rendezvous with a catheter advanced from the antegrade access, in-stent angioplasty can be performed to recanalize the stent and SFA. Direct retrograde puncture of an occluded stent may be considered an approach to recanalization in patients with stent occlusion and no inflow or outflow.

Failed superficial femoral artery intervention for advanced infrainguinal occlusive disease has a significant negative impact on limb salvage

Endovascular treatment of superficial femoral artery (SFA) lesions is a well-established practice. The repercussions of failed SFA interventions are unclear. Our goal was to review the efficacy of SFA stenting and define negative effects of its failure. A retrospective chart review was conducted from January 2007 to January 2010 that identified 42 limbs in 39 patients that underwent SFA stenting. Follow-up ankle-brachial index and a duplex ultrasound scan was performed at routine intervals. Mean patient age was 68 years (range, 43-88 years); there were 22 men (56%) and 17 women (44%). Intervention indication was claudication in 15 patients (36%), rest pain in seven patients (17%), and tissue loss in 19 patients (45%). There were 15 patients (36%) with TransAtlantic Inter-Society Consensus (TASC) A, nine patients (21%) with TASC B, five patients (12%) with TASC C, and 13 patients (31%) with TASC D lesions. The majority of lesions intervened on were the first attempt at revascularization. Three stents (7.7%) occluded within 30 days. One-year primary, primary-assisted, and secondary patency rates were 24%, 44%, and 51%, respectively. Limb salvage was 93% during follow-up. Seventeen interventions failed (40%) at 1 year. Of these, seven patients (41%) developed claudication, seven patients (41%) developed ischemic rest pain, and three patients (18%) were asymptomatic. During follow-up, three patients (7.7%) required bypass and three patients (7.7%) major amputation, one after failed bypass. All limbs requiring bypass or amputation had TASC C/D lesions. Thirty-day and 1-year mortality was 2.6% and 10.3%, respectively. Interventions performed for TASC C/D lesions are more likely to fail and more likely to lead to bypass or amputation. Interventions performed for TASC C/D lesions that fail have a negative impact on limb salvage. This should be considered when performing stenting of advanced SFA lesions.