[Interventional Treatments for Femoropopliteal Arterial Disease and Recent Updates]

Abstract

Peripheral arterial occlusive disease (PAOD) of the femoropopliteal artery is commonly caused by atherosclerosis. It can present with varying clinical symptoms depending on the degree of disease, ranging from intermittent claudication to critical limb ischemia and tissue loss. Therefore, appropriate and timely treatment is required to improve symptoms and salvage the affected limbs. Interventional approaches for femoropopliteal arterial disease commonly include percutaneous transluminal angioplasty, atherectomy, and stent placement. Over the years, endovascular recanalization has been widely performed for treating PAOD due to continuous developments in its techniques and availability of dedicated devices with the inherent advantage of being minimal invasive. In this review, we introduce various types of endovascular treatment methods, discuss the results of clinical research from existing literature, and illustrate the treatment procedures using representative images.

Fig. 1. A 72-year-old male patient with intermittent claudication.

A. Angiographic image shows multiple stenoses in the right SFA (arrows). B, C. A 5 × 200-mm pre-balloon and 6 × 150-mm drug-coated balloon were inflated in the stenotic segment of the right SFA. D. Final angiography shows improvement of the stenoses. SFA = superficial femoral artery

Fig. 2. A 79-year-old male patient who presented with intermittent claudication.

A. Angiographic image shows segmental, moderate stenosis with eccentric severe stenosis (arrow) in the left proximal SFA. B. A 6 × 120-mm balloon was inflated in the stenotic segment of the left SFA. C. Follow-up angiogram shows segmental dissection (arrows) in the prior ballooning segment. D. A 6 × 80-mm drug eluting stent was deployed in the dissection segment. E. Final angiography shows improvement of the dissected segment. SFA = superficial femoral artery

Fig. 3. Intraluminal angioplasty and subintimal angioplasty.

A. Intraluminal angioplasty: the catheter and guidewire are located in the true lumen (arrows). B. Subintimal angioplasty: the catheter and guidewire are located in the false lumen outside the intima; the false lumen is extended to replace the true lumen (arrows). Adapted from Korean Society of Interventional Radiology. Interventional radiology. 2nd ed. Seoul: Ilchokak 2014 (47).