Management of superficial femoral artery occlusive disease

The prevalence of intermittent claudication in men aged 55-74 years is 4.5 per cent and a common cause of such claudication is superficial femoral artery (SFA) occlusive disease. The preferred management of patients with this condition remains a subject of discussion. Therapeutic options range from conservative treatment to endovascular intervention and surgical bypass or endarterectomy. Conservative therapy is the primary treatment of choice. However, if this fails and an endovascular technique is chosen, percutaneous transluminal angioplasty (PTA) is the best option; other endovascular methods have failed to achieve higher rates of technical success or patency. PTA should be considered only for short lesions (< or = 10 cm). The usual surgical option for SFA occlusive disease is femoropopliteal bypass using autogenous vein, which has an expected 5-year patency rate of 56-76 per cent. Patency rates decrease if other types of graft are used. An alternative to vein bypass is endarterectomy, with an expected 5-year patency rate of 35-71 per cent. A multicentre randomized trial should be conducted to determine the optimal management of claudication caused by SFA occlusive disease.