Superficial Femoral Artery Is Not Left Anterior Descending Artery
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The past half-decade has witnessed unprecedented improvement in outcomes for patients with peripheral artery disease subjected to mechanical endovascular therapies.1 Once an afterthought coronary technology backwater, minimally invasive treatment of peripheral artery disease has emerged as frontline strategy for patients with medically refractory symptoms. We are now equipped with devices designed specifically for the peripheral vasculature: specialized crossing wires and catheters, debulking tools, drug-coated stents (DCSs), and drug-coated balloons (DCBs). Annual treatment failure rates are down from 20% to 30% to <3%.2 This remarkable trend has been accompanied by equally impressive growth in our understanding of peripheral artery atherosclerosis, the result of state-of-the-art noninvasive imaging, histopathological analyses, and gene-profiling studies. Is it technology, biology, or the biology behind technology that has fueled this unrivaled success over such a short period of time?
The fact that the superficial femoral artery (SFA) is located within a fibromuscular canal and is subjected to highly dynamic forces of flexion, extension, shortening, and torsion clearly distinguishes it from the coronary arteries. These mechanical forces are known to impart to the SFA cyclic circumferential strain and deformation, promoting cellular proliferation, chronic vessel injury, and perturbations in the expression of several genes hypothesized to accelerate atherosclerosis. In light of these realities, there has been a concerted effort to apply strategies and technologies to infrainguinal arteries that have served us well in treating coronary artery disease. Excepting a few notable bright spots, this approach has been woefully inadequate, with only modest treatment success of peripheral artery interventions becoming the accepted norm. The SFA is prone to …