Treating Femoropopliteal Disease: Established and Emerging Technologies

 

 Buy Article Permissions and Reprints

Abstract

The femoropopliteal artery is the most common site of disease in patients with peripheral arterial disease and presents some of the greatest challenges for interventional radiology. Many patients can be managed with medical treatment combined with supervised exercise alone. However, a significant proportion, especially those suffering from severe intermittent claudication or critical limb ischemia, will require some form of endovascular or surgical revascularization procedure. During the past few years an endovascular-first approach has gained support from all vascular specialties. Today, even complex lesions can be treated successfully with an endovascular approach. Unfortunately, the unique bio-mechanical properties of this vascular segment have limited long-term patency rates and clinical value of the endovascular options. In this review, the authors discuss the methods and techniques for treatment of femoropopliteal lesions and review the current evidence for commercially available devices on patency outcomes following successful recanalization.

• References

• 1 Kasapis C, Gurm HS. Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review. Curr Cardiol Rev 2009; 5 (4) 296-311
  CrossrefPubMedGoogle Scholar
• 2 Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31 (1, Pt 2): S1-S296
  CrossrefPubMedGoogle Scholar
• 3 Norgren L, Hiatt WR, Dormandy JA , et al; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33 (Suppl. 01) S1-S75
  CrossrefPubMedGoogle Scholar
• 4 Rooke TW, Hirsch AT, Misra S , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society for Vascular Medicine, and Society for Vascular Surgery. J Vasc Surg 2011; 54 (5) e32-e58
  CrossrefPubMedGoogle Scholar
• 5 Tendera M, Aboyans V, Bartelink ML , et al; European Stroke Organisation; ESC Committee for Practice Guidelines. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32 (22) 2851-2906
  CrossrefPubMedGoogle Scholar
• 6 Murphy TP, Reynolds MR, Cohen DJ , et al. Correlation of patient-reported symptom outcomes and treadmill test outcomes after treatment for aortoiliac claudication. J Vasc Interv Radiol 2013; 24 (10) 1427-1435 , quiz 1436
  CrossrefPubMedGoogle Scholar
• 7 Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of practice for superficial femoral and popliteal artery angioplasty and stenting. Cardiovasc Intervent Radiol 2014; 37 (3) 592-603
  CrossrefPubMedGoogle Scholar
• 8 Geronemus AR, Peña CS. Endovascular treatment of femoral-popliteal disease. Semin Intervent Radiol 2009; 26 (4) 303-314
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 NICE. Clinical Guideline 147: Lower Limb Peripheral Arterial Disease: Diagnosis and Management. Available at: http://www.nice.org.uk
  PubMedGoogle Scholar
• 10 Bolia A, Brennan J, Bell PR. Recanalisation of femoro-popliteal occlusions: improving success rate by subintimal recanalisation. Clin Radiol 1989; 40 (3) 325
  PubMedGoogle Scholar
• 11 Reekers JA, Bolia A. Percutaneous intentional extraluminal (subintimal) recanalization: how to do it yourself. Eur J Radiol 1998; 28 (3) 192-198
  CrossrefPubMedGoogle Scholar
• 12 Met R, Van Lienden KP, Koelemay MJ, Bipat S, Legemate DA, Reekers JA. Subintimal angioplasty for peripheral arterial occlusive disease: a systematic review. Cardiovasc Intervent Radiol 2008; 31 (4) 687-697
  CrossrefPubMedGoogle Scholar
• 13 Katsanos K, Spiliopoulos S, Karunanithy N, Krokidis M, Sabharwal T, Taylor P. Bayesian network meta-analysis of nitinol stents, covered stents, drug-eluting stents, and drug-coated balloons in the femoropopliteal artery. J Vasc Surg 2014; 59 (4) 1123-1133 , e8
  CrossrefPubMedGoogle Scholar
• 14 Cassese S, Byrne RA, Ott I , et al. Paclitaxel-coated versus uncoated balloon angioplasty reduces target lesion revascularization in patients with femoropopliteal arterial disease: a meta-analysis of randomized trials. Circ Cardiovasc Interv 2012; 5 (4) 582-589
  CrossrefPubMedGoogle Scholar
• 15 Kasapis C, Henke PK, Chetcuti SJ , et al. Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials. Eur Heart J 2009; 30 (1) 44-55
  PubMedGoogle Scholar
• 16 Kessel DO, Samson RH. What is the evidence for the efficacy of cryoplasty?. J Cardiovasc Surg (Torino) 2008; 49 (2) 179-185
  PubMedGoogle Scholar
• 17 Spiliopoulos S, Katsanos K, Karnabatidis D , et al. Cryoplasty versus conventional balloon angioplasty of the femoropopliteal artery in diabetic patients: long-term results from a prospective randomized single-center controlled trial. Cardiovasc Intervent Radiol 2010; 33 (5) 929-938
  CrossrefPubMedGoogle Scholar
• 18 Muradin GS, Bosch JL, Stijnen T, Hunink MG. Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease: meta-analysis. Radiology 2001; 221 (1) 137-145
  CrossrefPubMedGoogle Scholar
• 19 Pastromas G, Katsanos K, Krokidis M, Karnabatidis D, Spiliopoulos S. Emerging stent and balloon technologies in the femoropopliteal arteries. ScientificWorldJournal 2014; 2014: 695402
  PubMedGoogle Scholar
• 20 Acin F, de Haro J, Bleda S, Varela C, Esparza L. Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials. J Endovasc Ther 2012; 19 (5) 585-595
  CrossrefPubMedGoogle Scholar
• 21 Perrio S, Holt PJ, Patterson BO, Hinchliffe RJ, Loftus IM, Thompson MM. Role of superficial femoral artery stents in the management of arterial occlusive disease: review of current evidence. Vascular 2010; 18 (2) 82-92
  CrossrefPubMedGoogle Scholar
• 22 Duda SH, Pusich B, Richter G , et al. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-month results. Circulation 2002; 106 (12) 1505-1509
  CrossrefPubMedGoogle Scholar
• 23 Duda SH, Bosiers M, Lammer J , et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther 2006; 13 (6) 701-710
  CrossrefPubMedGoogle Scholar
• 24 Dake MD, Ansel GM, Jaff MR , et al; Zilver PTX Investigators. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv 2011; 4 (5) 495-504
  CrossrefPubMedGoogle Scholar
• 25 Dake MD, Ansel GM, Jaff MR , et al; Zilver PTX Investigators. Sustained safety and effectiveness of paclitaxel-eluting stents for femoropopliteal lesions: 2-year follow-up from the Zilver PTX randomized and single-arm clinical studies. J Am Coll Cardiol 2013; 61 (24) 2417-2427
  CrossrefPubMedGoogle Scholar
• 26 Saxon RR, Dake MD, Volgelzang RL, Katzen BT, Becker GJ. Randomized, multicenter study comparing expanded polytetrafluoroethylene-covered endoprosthesis placement with percutaneous transluminal angioplasty in the treatment of superficial femoral artery occlusive disease. J Vasc Interv Radiol 2008; 19 (6) 823-832
  CrossrefPubMedGoogle Scholar
• 27 Lammer J, Zeller T, Hausegger KA , et al. Heparin-bonded covered stents versus bare-metal stents for complex femoropopliteal artery lesions: the randomized VIASTAR trial (Viabahn endoprosthesis with PROPATEN bioactive surface [VIA] versus bare nitinol stent in the treatment of long lesions in superficial femoral artery occlusive disease). J Am Coll Cardiol 2013; 62 (15) 1320-1327
  CrossrefPubMedGoogle Scholar
• 28 Diamantopoulos A, Gupta Y, Zayed H, Katsanos K. Paclitaxel-coated balloons and aneurysm formation in peripheral vessels. J Vasc Surg 2014; ; epub ahead of print
  PubMedGoogle Scholar
• 29 Vermassen F, Bouckenooghe I, Moreels N, Goverde P, Schroe H. Role of bioresorbable stents in the superficial femoral artery. J Cardiovasc Surg (Torino) 2013; 54 (2) 225-234
  PubMedGoogle Scholar
• 30 Werner M, Micari A, Cioppa A , et al. Evaluation of the biodegradable peripheral Igaki-Tamai stent in the treatment of de novo lesions in the superficial femoral artery: the GAIA study. JACC Cardiovasc Interv 2014; 7 (3) 305-312
  CrossrefPubMedGoogle Scholar