title: Outcome after endovascular treatment of deep femoral artery stenosis: results in a consecutive patient series and systematic review of the literature.
abstract: OBJECTIVE
  To evaluate immediate and midterm clinical outcomes after percutaneous transluminal angioplasty (PTA) of deep femoral artery stenosis in patients with chronically occluded superficial femoral arteries (SFA) and to report the results of a systematic review of the literature in this field.
  
  
  METHODS
  A retrospective analysis was conducted of 55 consecutive patients (42 men; median age 72 years, interquartile range [IQR] 63-79) with severe intermittent claudication (n = 38) or critical limb ischemia (n = 17) who underwent balloon angioplasty of deep femoral artery stenosis. Patients were followed with ankle-brachial index (ABI) measurement, estimation of maximum walking capacity, clinical staging of peripheral artery disease (PAD), and duplex ultrasound imaging for restenosis. A systematic review of the literature using MEDLINE, EMBASE, and a hand search was done.
  
  
  RESULTS
  Technical success (residual stenosis < 30%) was achieved in 85% (47/55), with 1 (2%) minor complication. The median ABI marginally increased from 0.48 at baseline to 0.53 post intervention without significant difference in the change of ABI between patients with supra- or infragenicular reconstitution of the femoropopliteal runoff. During a median 13-month (IQR 3-42) follow-up, no significant improvement in ABI or walking distance was maintained, and only 16 (29%) patients reported a sustained clinical improvement by 1 PAD stage. Cumulative patency and reintervention-free survival rates were, respectively, 71% and 61% at 1 year and 49% and 48% at 3 years. In the literature, only case series were found, but no randomized trial evaluating the efficacy of deep femoral artery PTA.
  
  
  CONCLUSIONS
  PTA of the deep femoral artery can be performed with high technical success rates at a low interventional risk. However, in the majority of patients, this technique yields no sustained hemodynamic or clinical benefit. Due to a high rate of late failures, it should be reserved for limb salvage in patients without a surgical alternative.
authors.affiliation: Department of Angiology, Vienna General Hospital, Medical University, Vienna, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Dick
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
authors.forename: Schila
authors.initials: S
authors.lastname: Sabeti
authors.forename: Jasmin
authors.initials: J
authors.lastname: Amighi
authors.forename: Oliver
authors.initials: O
authors.lastname: Schlager
authors.forename: Markus
authors.initials: M
authors.lastname: Haumer
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014654:Vascular Patency