Update on SFA Interventions
Superficial femoral artery (SFA) revascularization continues to be among the most commonly performed—and debated—procedures in the vascular arena. The combination of the wide variety of specialties involved, seemingly myriad therapeutic options available, and the naturally challenging anatomy fosters a global, perennial discussion that moves from one lecture hall to the next (even in the current virtual era).
And yet, despite this discussion dating back at least to Dr. Dotter’s first SFA angioplasty in 1964, many key questions remain areas of debate rather than consensus: When to intervene and in whom? Interventional, surgical, medical, or exercise? If interventional, by what means? Although also subject to ability, availability, and reimbursement, these decisions ultimately come down to judgment calls regarding the unique needs of the patient and which option will preserve their functional abilities the longest.
The past few years have seen both innovation and controversy. The aforementioned debates continue, and a new one emerged regarding the safety of some of the most studied and widely used devices. In this edition of Endovascular Today, we have invited experts from around the world to share updates on key SFA procedures and technologies, as well as the forces affecting how and when they are used.
It has now been almost 2 years since a Journal of the American Heart Association meta-analysis was published linking paclitaxel and mortality in lower extremity arterial disease. To open our SFA feature, Daniel J. Bertges, MD; Theodosios Bisdas, MD; Bruce H. Gray, DO; Ramon L. Varcoe, MBBS; and Sabine Steiner, MD, share lessons learned since the meta-analysis, including how device use has changed, conversations with patients about safety and informed consent, and how we can move forward. Also included in this article is an interview with Jos C. van den Berg, MD, about the new United Kingdom/Europe indications for use of several paclitaxel-coated balloons and stents. Next, we spoke to representatives from the FDA’s Center for Devices and Radiological Health about paclitaxel-coated device use, covering safety, new data, and implications for the peripheral trial landscape.
Shifting away from the paclitaxel discussion, Osamu Iida, MD; Yosuke Hata, MD; and Naoya Kurata, BHS, highlight the role of intravascular ultrasound for femoropopliteal lesion treatment, a tool that can collect data on vessel and lesion characteristics to improve the success of intervention. Sreekumar Madassery, MD, and Eric C. King, MD, then provide an overview of the armamentarium for atherectomy and thrombectomy devices for treatment of the SFA, sharing unique features of various devices as well as the available data.
Next, we spoke with radial access experts Sabeen Dhand, MD, and Aaron M. Fischman, MD, on where we stand with respect to progress on this alternative access for infrainguinal applications. Finally, Anna Krawisz, MD, and Dr. Secemsky outline the aims of a newly awarded National Heart, Lung, and Blood Institute grant intended to investigate how shared decision-making can be incorporated into routine vascular care.
Elsewhere in this issue is an enlightening interview with Nicholas G. Inston, PhD, on research and innovation in vascular access, medical education in the pandemic era, and his work with the Transplant Links Community charity.
We hope you find this edition timely and practical, and we are grateful to the authors and panelists who contributed to this edition of Endovascular Today, in particular for the time they have given during the pandemic.
Yann Gouëffic, MD, PhD
Eric A. Secemsky, MD, MSc