Interventional Strategies for the Superficial Femoral Artery

The incidence of peripheral arterial disease (PAD) is rising due to significant increase in metabolic disease such as diabetes mellitus, increase in aging population, and tobacco use. Superficial femoral artery (SFA) disease is the leading cause of peripheral artery disease and claudication. In the last decades, several technologies/techniques have been developed for the treatment of SFA atherosclerotic disease including balloon angioplasty, balloon expanding stents, self-expanding stents, drug-eluting balloon, and atherectomy. The advances made in technology have significantly improved the quality of the balloons, but they have limitations especially in long and calcified lesions. While the initial studies using stainless steel stents failed to show any significant difference in outcomes, understanding the pathophysiology and improvement in stent technologies has shown significant reduction of restenosis by fiveto sevenfold when compared to angioplasty alone. Atherectomy is another modality of plaque modification and treatment, which can be done as a stand-alone treatment or more commonly combined with PTA and/or stenting. Finally, several randomized studies and registries have showed that with improvement in technology, there is significant improvement in long-term outcomes of SFA atherosclerotic disease.