Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review

Abstract

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease.

Keywords: Peripheral arterial disease; diagnosis; management.; popliteal artery; superficial femoral artery.

Fig. (1)

Weighted mean prevalence of intermittent claudication (symptomatic PAD) in large population-based studies. Reproduced with permission from [7].

Fig. (2)

Approximate range of odds ratios for risk factors for symptomatic peripheral arterial disease. Reproduced with permission from [7].

Fig. (3)

Algorithm for diagnosis of peripheral arterial disease. TBI – toe brachial index; VWF – velocity wave form; PVR – pulse volume recording. Reproduced with permission from Hiatt WR. N Engl J Med 2001; 344: 1608-21.

Fig. (4)

Overall treatment strategy for peripheral arterial disease. BP – blood pressure; HbA1c – hemoglobin A1c; LDL – low density lipoprotein; MRA – magnetic resonance angiography; CTA – computed tomographic angiography. Reproduced with permission from Hiatt WR. N Engl J Med 2001; 344: 1608-21.

Fig. (5)

Algorithm for treatment of the patient with critical limb ischemia. Contraindications are: patients not fit for revascularization; revascularization not technically possible; benefit cannot be expected (i.e. widespread ulceration-gangrene). CLI – critical limb ischemia; MRA – magnetic resonance angiography; CTA – computed tomographic angiography. Reproduced with permission from [7].

Fig. (6)

TASC classification of femoral popliteal lesions. CFA – common femoral artery; SFA – superficial femoral artery. Reproduced with permission from [7].