Limitations of percutaneous transluminal angioplasty with stenting for femoropopliteal arterial occlusive disease

Purpose: To review the results of intravascular stents used to treat superficial femoral artery (SFA) occlusive disease and to assist in patient selection for this procedure. Methods and results: We evaluated 55 patients who underwent balloon angioplasty and stenting of SFA long-segment disease and compared the results with those in the current literature. In our patient group, the SFA mean lesion length was 16.5 cm with the resting ankle-brachial index of 0.48 ± 0.19. Hemodynamic improvement to an ABI of 0.71 ± 0.23 (P= .001) and clinical benefit (56%) were maintained at 13.8 months. Primary and secondary patency rates were 22% and 46%, respectively, at 12 months. The literature reports patency rates of 29% to 81% primarily and 43% to 96% secondarily. However, the mean lesion length in these reports varied from 3.7 cm to 13.5 cm, and most of these patients had claudication (50% to 92%). Other variable factors determining long-term success may include the number and type of stent, artery occlusion versus stenoses, presence of diabetes mellitus, and smoking status. Conclusions: Stenting of short-segment SFA disease remains patent more frequently than for long-segment disease, and may be applicable in patients with disabling claudication or critical limb ischemia. Surgical revascularization is preferred for long-segment disease, with stenting reserved for patients with limb-threatening ischemia and no surgical alternative.