Approach to Superficial Femoral Artery Disease скачать в хорошем качестве

Approach to Superficial Femoral Artery Disease

#SuperficialFemoralArtery #SFA #PeripheralArterialDisease #PAD #Claudication #CriticalLimbIschaemia #Angioplasty #DrugCoatedBalloon #DrugElutingStent #PeripheralArterialGram #Stenosis #Occlusion #NewIntimalHyperplasia #VascularIntervention This video by Dr Gregory Weir outlines his approach to managing **superficial femoral artery (SFA) disease**, a specific form of **peripheral arterial disease (PAD)**. He begins by emphasising the anatomy of the SFA, which branches from the common femoral artery and runs anterior and then medial to the femur, becoming the popliteal artery behind the knee. He notes that disease commonly affects the distal aspect of the SFA, particularly in patients with a history of smoking. Dr Weir discusses the indications for intervention in SFA disease. *Severe limiting claudication* is considered a relative indication, while *rest pain, non-healing ulceration, and gangrene* of the toes or foot are absolute indications. When intervention is indicated, his initial approach is always **endovascular first**, involving a **peripheral arteriogram**. He typically performs this via the contralateral femoral artery to assess flow from the aorta down to the SFA and exclude more proximal disease. For a *stenosis* of the SFA, Dr Weir's first-line treatment is *plain old balloon angioplasty**. If this yields a good radiological outcome, his preference is a **drug-coated balloon (DCB)* or **drug-eluting balloon (DEB)**. However, if the initial balloon angioplasty has a poor radiological outcome, he would consider using a **drug-coated or drug-eluting stent**. The approach differs for a complete *occlusion* of the SFA. If a guide wire can be passed through the occlusion, he would still start with plain balloon angioplasty but would have a low threshold to follow with a DCB or drug-eluting stent due to the high risk of re-occlusion in a completely blocked vessel. According to Dr Weir, using only a DCB after a poor outcome from balloon angioplasty in a completely occluded vessel "does not make sense". If he is unable to pass a guide wire through the complete occlusion, surgery would be indicated. Dr Weir concludes by highlighting that *new intimal hyperplasia* is the major threat to the long-term success of SFA interventions, hence his low threshold for using drug-coated balloons or stents. This video describes my personal approach to the management of peripheral arterial disease of the superficial femoral artery, based on the current scientific data.