SCAI Publishes Appropriate Use Guidance on Femoropopliteal Treatment

June 12, 2014—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the publication of a new appropriate use expert consensus document to provide guidance for femoropopliteal arterial interventions. The SCAI noted that blockage affecting arteries above the knee is the most common form of peripheral artery disease (PAD). The document was published by Andrew J. Klein MD, et al and is available online in Catheterization and Cardiovascular Interventions.

The document is the second in a series of PAD treatment recommendations released by SCAI that are aimed at helping physicians determine treatment options for the growing number of patients impacted by PAD. On May 28, SCAI announced the publication by Dr. Klein et al of new recommendations that provide new anatomic, clinical, and technical guidance for the endovascular treatment of aortoiliac PAD. Forthcoming publications will address infrapopliteal PAD and renal artery stenosis.

In SCAI’s announcement on the femoropopliteal treatment guidance, the consensus paper’s senior author, Douglas E. Drachman, MD, commented, “Our goal in treating patients with femoropopliteal disease is to reduce pain, improve walking ability, and enhance quality of life. As technology has advanced, there are now safe and effective endovascular treatment options for a range of patients, not just those at high surgical risk.” Dr. Drachman is Director of the Cardiology Fellowship Program at Massachusetts General Hospital.

This document was developed to guide physicians in the clinical decision making related to the contemporary application of endovascular intervention among patients with femoropopliteal arterial disease.

An expert panel developed the new recommendations by reviewing scientific data available on each treatment option. The panel found that balloon angioplasty continues to be a valid treatment, but with suboptimal long-term results in patients with long blockages, critical limb ischemia, diabetes, or areas of complete blockage. The paper discusses use of self-expanding stents, covered stents, and nonstenting alternatives, including atherectomy.

As summarized in the document’s conclusions, “Successful endovascular intervention for femoropopliteal artery disease provides relief of claudication and offers limb salvage in cases of CLI (critical limb ischemia). Technologies and operator technique have evolved to the point that we may now provide effective endovascular therapy for a spectrum of lesions, patients, and clinical scenarios. Endovascular treatment of this segment offers a significant alternative to surgical revascularization and may offer improved safety for a wide range of patients, not solely those deemed high surgical risk. Although endovascular therapy of the femoropopliteal segment has historically been hampered by high rates of restenosis, emerging technologies, including drug-eluting stents, drug-coated balloons, and perhaps bioabsorbable stent platforms, provide future hope for more durable patency in complex disease. By combining lessons learned from clinical trials, international trends in clinical practice, and insights regarding emerging technologies, we may appropriately tailor our application of endovascular therapy to provide optimal care to our patients.”