What is the role of Femoral Angioplasty in the treatment of Peripheral Vascular Disease (PVD)?

From the Guidelines

Femoral angioplasty with drug-eluting treatment should be considered as the first-choice strategy for patients with symptomatic peripheral arterial disease in the femoro-popliteal lesions. This minimally invasive procedure involves inserting a balloon catheter into the narrowed femoral artery to widen it and restore blood flow to the lower extremities 1. The procedure is typically performed under local anesthesia with sedation and takes 1-2 hours. Before the procedure, patients should undergo comprehensive vascular imaging (duplex ultrasound, CT angiography, or MR angiography) to assess the extent and location of stenosis. Patients should receive antiplatelet therapy (aspirin 81-325mg daily) before the procedure and continue indefinitely afterward 1. During the procedure, heparin (typically 5000 units IV) is administered to prevent thrombosis. Following angioplasty, patients often receive dual antiplatelet therapy with aspirin plus clopidogrel 75mg daily for at least 1 month. Stent placement may be necessary in cases of elastic recoil, dissection, or residual stenosis >30%.

Some key points to consider when performing femoral angioplasty include:

• The use of self-expandable nitinol stents, which have been shown to improve mid-term patency rates compared to angioplasty alone 1
• The decision to stent the superficial femoral artery is based mainly on the clinical indication for revascularization and on the lesion length and complexity
• In-stent restenosis is a major drawback of stent implantation, and there is currently no proof of any impact of stent design on restenosis rates 1
• Covered stents (stent grafts) appear to be a viable option for the treatment of complex superficial femoral artery lesions, with outcomes comparable with prosthetic above-knee femoropopliteal bypass surgery 1

Post-procedure care includes monitoring the puncture site for bleeding, assessing distal pulses, and encouraging ambulation within 6-8 hours. Patients should be advised to report symptoms of restenosis (recurrent claudication, rest pain) and continue risk factor modification including smoking cessation, diabetes management, lipid control with statins, and regular exercise. The procedure works by physically expanding the vessel lumen, compressing plaque against the arterial wall, and improving distal perfusion, which alleviates symptoms of claudication and prevents progression to critical limb ischemia.

From the Research

Femoral Angioplasty for PVD

• Femoral angioplasty is a minimally invasive procedure used to treat peripheral arterial disease (PAD) in the femoral artery 2, 3.
• The procedure involves inflating a balloon to widen the narrowed artery and may also involve the placement of a stent to keep the artery open 2, 4.
• Studies have shown that femoral angioplasty can be an effective treatment for PAD, with primary patency rates at 24 months ranging from 49% to 67% 2.
• The choice of treatment, either angioplasty or surgical bypass, depends on the severity of the disease and the patient's overall health 2, 3.

Comparison of Angioplasty and Stenting

• Research has compared the outcomes of angioplasty alone versus angioplasty with stenting for superficial femoral artery lesions 4.
• The results showed a small but statistically significant improvement in primary angiographic and duplex patency at six months in patients treated with PTA plus stent over lesions treated with PTA alone 4.
• However, the benefit of stenting was not significant at 12 and 24 months, and the decision to use stenting should be made on a case-by-case basis 4.

Antiplatelet Therapy

• Antiplatelet therapy is an important aspect of treatment for PAD, and dual antiplatelet therapy (DAT) may be beneficial for patients who have undergone peripheral percutaneous revascularization 5, 6.
• The duration of DAT can vary, but 1-3 months of DAT appears reasonable after percutaneous revascularization of the superficial femoral artery in low-risk settings 6.
• Individualized therapy, taking into account the severity of the disease and the patient's overall health, is recommended when deciding on antiplatelet therapy 6.