Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

Abstract

This is a Standards of Practice document endorsed by CIRSE. The authors performed a literature review and provide recommendations and quality improvement guidelines based on the most recent and highest level of evidence available to date on the field of Superficial Femoral and Popliteal Artery Angioplasty and Stenting. Standards for the use of basic and more advanced endovascular techniques in the femoropopliteal arteries are reported and relevant aspects of case selection, imaging, follow-up, and overall patient management are presented to guide endovascular practice in Europe.

Use of a New Hybrid Heparin-Bonded Nitinol Ring Stent in the Popliteal Artery: Procedural and Mid-term Clinical and Anatomical Outcomes

“…Percutaneous transluminal angioplasty has emerged in the recent years as the preferred initial treatment option for endovascular management of symptomatic femoropopliteal arterial disease, with stent placement usually reserved for bail out situations [1,3]. Nitinol stents have been widely used in the superficial femoral and popliteal artery mainly on a provisional basis following balloon angioplasty in order to deal with flow limiting dissections, vessel trauma or elastic recoil but also for primary stenting mainly in cases of acute or sub-acute occlusive disease [1].…”

“…Specifically, scientific evidence on patency rates of stenting within the challenging anatomy of the popliteal segment remains limited and quite controversial [1,3]. Unlike the SFA, the popliteal artery is exposed to extensive multiple external biomechanical forces, such as flexion, extension, compression and torsion applied to the vessel during movement of the knee [9][10][11][12]19].…”

“…Endovascular treatment of the femoropopliteal segment has been increasingly employed for treatment of complex atherosclerotic disease in patients suffering from peripheral arterial disease (PAD) [1][2][3]. The American College of Cardiology/American Heart Association 2005 Practice Guidelines for the Management of Patients with PAD and the 2007 Inter-Society Consensus for the Management of PAD (TASC II) advocate percutaneous transluminal angioplasty as the preferred initial treatment option for endovascular management of symptomatic femoropopliteal Aneeta Parthipun and Athanasios Diamantopoulos have equal contribution in this work and both qualify for first authorship position.…”

Tratamento da doença arterial obstrutiva periférica em território femoropoplíteo com stent primário: análise em até 24 meses

“…The majority of large studies published to date include patients with symptomatic PAOD, whose predominant symptom is intermittent claudication. [8][9][10][11] In such studies there are also significant numbers of patients with more than one runoff artery, which directly impacts the patency and TVR results. In contrast, our sample contained a large majority of patients with advanced critical ischemia (Rutherford 5 and 6).…”

Starclose SE® hemostasis after 6F direct antegrade superficial femoral artery access distal to the femoral head for peripheral endovascular procedures in obese patients

“…The micropuncture introducer was then exchanged over a 0.035-inch stiff guidewire (Amplatz Super Stiff TM , Boston Scientific; Radiofocus® Terumo) with a standard 6F arterial sheath. Following sheath positioning a bolus dose of 50 IU/kg of unfractioned heparin was administrated according to international guidelines (14,15). Following completion of endovascular revascularization, hemostasis was achieved with the nitinol clipbased, StarClose SE® extraluminal VCD, as previously described for antegrade access, after meticulously creating a subcutaneous canal for clip deployment using mosquito forceps for bland dissection and exchanging the arterial sheath with the sheath of the VCD over a nonhydrophilic stiff guidewire (Amplatz Super stiff ™ guidewire, Boston Scientific) (11)…”