Published 2020-11-06
Keywords
- femoral-popliteal lesion,
- peripheral artery disease,
- peripheral stent,
- stent failure,
- stenting
How to Cite
Copyright (c) 2020 Malaev D.U., Tarkova A.R., Prokhorkhin A.A., Merson D.L., Vinogradov A.Yu., Baystrukov V.I., Boykov A.A., Kretov E.I., Pryamov M.V.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Peripheral artery disease (PAD) is one of the most common cardiovascular diseases with serious sequelae. Every year, 120–500 amputations are performed per 1 million people worldwide. The severe consequences of amputation include the mental trauma caused by loss of a limb, disability and a real risk of death for the patient, since the mortality rate associated with the development of gangrene remains extremely high. PAD is most frequently located in the femoral-popliteal segment, which is the longest vascular segment in the human body. Over the past decade, the endovascular approach has become the main therapeutic strategy for PAD, given its lower risk of complications and comparable efficacy to open interventions. Femoral-popliteal stenting provides advantages over balloon angioplasty, preventing vessel wall recoil and providing necessary frame support.
This review aims to describe the latest progress of endovascular surgery for the treatment of femoral-popliteal artery disease and to discuss its limitations.
The introduction of nitinol stents and new drug coated stents into clinical practice has improved the results of femoral-popliteal endovascular treatment. Despite this, stent failure remains a pressing problem that significantly impacts the results of endovascular treatment of atherosclerotic lesions of lower limb arteries.
Received 6 June 2019. Revised 8 October 2019. Accepted 10 October 2019.
Funding: The study did not have sponsorship.
Conflict of interest: Authors declare no conflict of interest.
Author contributions
Conception and design: D.U. Malaev, A.R. Tarkova, A.A. Prokhorkhin, A.A. Boykov
Drafting the article: D.U. Malaev, A.A. Prokhorkhin, A.A. Boykov
Critical revision of the article: D.L. Merson, A.Yu. Vinogradov, V.I. Baystrukov, E.I. Kretov
Final approval of the version to be published: D.U. Malaev, A.R. Tarkova, A.A. Prokhorkhin, D.L. Merson, A.Yu. Vinogradov, V.I. Baystrukov, A.A. Boykov, E.I. Kretov, M.V. Pryamov
References
- Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G. TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67. PMID: 17223489. https://doi.org/10.1016/j.jvs.2006.12.037
- Fowkes F.G., Rudan D., Aboyans V., Denenberg J.O., McDermott M.M., Norman P.E., Sampson U.K., Williams L.J., Mensah G.A., Criqui M.H. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329-1340. PMID: 23915883. https://doi.org/10.1016/S0140-6736(13)61249-0
- White C.J. Atherosclerotic peripheral arterial disease. In: Goldman L., Schafer A.I., editors. Goldman-Cecil Medicine. Vol. 1. 25th ed. Elsevier Saunders; 2016. pp. 497-503.
- Criqui M.H., Aboyans V. Epidemiology of peripheral artery disease. Circulation Research. 2015;116(9):1509-1526. PMID: 25908725. https://doi.org/10.1161/CIRCRESAHA.116.303849
- Клиническая ангиология. Руководство для врачей в 2 томах. Под ред. А.В. Покровского. М.: Медицина, 2004. [Clinical angiology. Pokrovsky A.V., editor. Moscow: Medicine Publ., 2004. (In Russ.)]
- Kristensen M.T., Holm G., Kirketerp-Møller K., Krasheninnikoff M., Gebuhr P. Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do? Interac Cardiovasc Thorac Surg. 2012;14(5):543-547. PMID: 22298857, PMCID: PMC3329303. https://doi.org/10.1093/icvts/ivr075
- Ozkan U., Oguzkurt L., Tercan F. Atherosclerotic risk factors and segmental distribution in symptomatic peripheral artery disease. J Vasc Interv Radiol. 2009;20(4):437-441. PMID: 19328423. https://doi.org/10.1016/j.jvir.2009.01.010
- Maleckis K., Anttila E., Aylward P., Poulson W., Desyatova A., MacTaggart J., Kamenskiy A. Nitinol stents in the femoropopliteal artery: a mechanical perspective on material, design, and performance. Ann Biomed Eng. 2018;46(5):684-704. PMID: 29470746, PMCID: PMC5975366. https://doi.org/10.1007/s10439-018-1990-1
- Гавриленко А.В., Скрылев А.В. Хирургическое лечение больных с критической ишемией нижних конечностей, обусловленной поражениями артерий инфраингвинальной локализации. Ангиология и сосудистая хирургия. 2008;14(3):111-117. [Gavrilenko A.V., Skrylev S.I. Management of patients with lower limb critical ischaemia induced by lesions of infrainguinal arteries. Angiology and vascular surgery. 2008;14(3):111-117. (In Russ.)]
- Затевахин И.И., Шиповский В.Н., Золкин В.Н. Баллонная ангиопластика при ишемии нижних конечностей. Руководство для врачей. М.: Медицина, 2004. [Zatevakhin I.I., Shipovskii V.N., Zolkin V.N. Balloon angioplasty in lower limb ischemia. Moscow: Medicine Publ., 2004. (In Russ.)]
- Schillinger M., Minar E. Past, present and future of femoropopliteal stenting. J Endovasc Ther. 2009;16 Suppl 1:1147-1152. PMID: 19317587. https://doi.org/10.1583/1545-1550-16.16.I-147
- Balk E., Soledad Cepeda M., Ip S., Trikalinos T., O’Donnell T. Horizon scan of invasive interventions for lower extremity peripheral artery disease and systematic review of studies comparing stent placement to other interventions. Rockville, MD: Agency for Healthcare Research and Quality, 2008. PMID: 25473710.
- Neil N. Stent fracture in the superficial femoral and proximal popliteal arteries: literature summary and economic impacts. Perspect Vasc Surg Endovasc Ther. 2013;25(1-2):20-27. PMID: 24225504. https://doi.org/10.1177/1531003513509122
- Ansari F., Pack L.K., Brooks S.S., Morrison T.M. Design considerations for studies of the biomechanical environment of the femoropopliteal arteries. J Vasc Surg. 2013;58(3):804-813. PMID: 23870198. https://doi.org/10.1016/j.jvs.2013.03.052
- Desyatova A., MacTaggart J., Romarowski R, Poulson W., Conti M., Kamenskiy A. Effect of aging on mechanical stresses, deformations, and hemodynamics in human femoropopliteal artery due to limb flexion. Biomech Model Mechanobiol. 2018;17(1):181-189. PMID: 28815378, PMCID: PMC5809209. https://doi.org/10.1007/s10237-017-0953-z
- Smouse H., Nikanorov A., Laflash D. Biomechanical forces in the femoropopliteal arterial segment. Endovasc Today. 2005;4:60-66. Available from: https://evtoday.com/2005/06/EVT0605_F3_Smouse.html
- MacTaggart J.N., Phillips N.Y., Lomneth C.S., Pipinos I.I., Bowen R., Baxter B.T., Johanning J., Longo G.M., Desyatova A.S., Moulton M.J., Dzenis Y.A., Kamenskiy A.V. Three-dimensional bending, torsion and axial compression of the femoropopliteal artery during limb flexion. J Biomech. 2014;47(10):2249-2256. PMID: 24856888. https://doi.org/10.1016/j.jbiomech.2014.04.053
- Henry M., Amor M., Beyar I., Henry I., Porte J.M., Mentre B., Tricoche O., Ethevenot G. Clinical experience with a new nitinol self-expanding stent in peripheral artery disease. J Endovasc Surg. 1996;3(4):369-79. PMID: 8959493. https://doi.org/10.1583/1074-6218(1996)003<0369:CEWANN>2.0.CO;2
- Sabeti S., Amighi J., Ahmadi R., Minar E., Schillinger M. Primary patency of long-segment self-expanding nitinol stents in the femoropopliteal arteries. J Endovasc Ther. 2005;12(1):6-12. PMID: 15683273. https://doi.org/10.1583/04-1359.1
- Schillinger M., Sabeti S., Loewe C., Dick P., Amighi J., Mlekusch W., Schlager O., Cejna M., Lammer J., Minar E. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879-1888. PMID: 16672699. https://doi.org/10.1056/NEJMoa051303
- Schillinger M., Sabeti S., Dick P., Amighi J., Mlekusch W., Schlager O., Loewe C., Cejna M., Lammer J., Minar E. Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting. Circulation. 2007;115(21):2745-2749. PMID: 17502568. https://doi.org/10.1161/CIRCULATIONAHA.107.688341
- Laird J.R., Katzen B.T., Scheinert D., Lammer J., Carpenter J., Buchbinder M., Dave R., Ansel G., Lansky A., Cristea E., Collins T.J., Goldstein J., Jaff M.R.; RESILIENT Investigators. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve-month results from the RESILIENT randomized trial. Circ Cardiovasc Interv. 2010:3(3):267-276. PMID: 20484101. https://doi.org/10.1161/CIRCINTERVENTIONS.109.903468
- Dick P., Wallner H., Sabeti S., Loewe C., Mlekusch W., Lammer J., Koppensteiner R., Minar E., Schillinger M. Balloon angioplasty versus stenting with nitinol stents in intermediate length superficial femoral artery lesions. Catheter Cardiovasc Interv. 2009;74:1090-1095. https://doi.org/10.1002/ccd.22128
- Vent P.A., Kaladji A., Davaine J.M., Guyomarch B., Chaillou P., Costargent A., Quillard T., Gouëffic Y. Bare metal versus paclitaxel-eluting stents for long femoropopliteal lesions: prospective cohorts comparison using a propensity score-matched analysis. Ann Vasc Surg. 2017;43:166-175. PMID: 28300676. https://doi.org/10.1016/j.avsg.2016.10.058
- Ding Y., Zhou M., Wang Y., Cai L., Shi Z. Comparison of drug-eluting stent with bare-metal stent implantation in femoropopliteal artery disease: a systematic review and meta-analysis. Ann Vasc Surg. 2018;50:96-105. PMID: 29514049. https://doi.org/10.1016/j.avsg.2017.12.003
- Dake M.D., Ansel G.M., Jaff M.R., Ohki T., Saxon R.R., Smouse H.B., Zeller T., Roubin G.S., Burket M.W., Khatib Y., Snyder S.A., Ragheb A.O., White J.K., Machan L.S.; Zilver PTX Investigators. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv. 2011;4(5):495-504. PMID: 21953370. https://doi.org/10.1161/CIRCINTERVENTIONS.111.962324
- Dake M.D., Ansel G.M., Jaff M.R., Ohki T., Saxon R.R., Smouse H.B., Machan L.S., Snyder S.A., O'Leary E.E., Ragheb A.O., Zeller T.; Zilver PTX Investigators. Durable clinical effectiveness with paclitaxel-eluting stents in the femoropopliteal artery: 5-year results of the Zilver PTX randomized trial. Circulation. 2016;133(15):1472-1483. PMID: 26969758, PMCID: PMC4823823. https://doi.org/10.1161/CIRCULATIONAHA.115.016900
- Дыгай А.М. К вопросу об антипролиферативном покрытии коронарных стентов. Патология кровообращения и кардиохирургия. 2018;22(2):22-29. http://dx.doi.org/10.21688/1681-3472-2018-2-22-29 [Digay A.M. On the question of the antiproliferative coating of coronary stents. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2018;22(2):22-29. (In Russ.) http://dx.doi.org/10.21688/1681-3472-2018-2-22-29]
- Bisdas T., Beropoulis E., Argyriou A., Torsello G., Stavroulakis K. 1-year all-comers analysis of the eluvia drug-eluting stent for long femoropopliteal lesions after suboptimal angioplasty. JACC Cardiovasc Interv. 2018;11(10):957-966. PMID: 29798772. https://doi.org/10.1016/j.jcin.2018.03.046
- Muller-Hulsbeck S., Keirse K., Zeller T., Schroe H., Diaz-Cartelle J. Long-term results from the MAJESTIC trial of the eluvia paclitaxel-eluting stent for femoropopliteal treatment: 3-year follow-up. Cardiovasc Intervent Radiol. 2017;40(12):1832-1838. PMID: 28948322. https://doi.org/10.1007/s00270-017-1771-5
- Gray W.A., Keirse K., Soga Y., Benko A., Babaev A., Yokoi Y., Schroeder H., Prem J.T., Holden A., Popma J., Jaff M.R., Diaz-Cartelle J., Müller-Hülsbeck S.; IMPERIAL investigators. A polymer-coated, paclitaxel-eluting stent (Eluvia) versus a polymer-free, paclitaxel-coated stent (Zilver PTX) for endovascular femoropopliteal intervention (IMPERIAL): a randomised, non-inferiority trial. Lancet. 2018;392(10157):1541-1551. PMID: 30262332. https://doi.org/10.1016/S0140-6736(18)32262-1
- Duda S.H., Pusich B., Richter G., Landwehr P., Oliva V.L., Tielbeek A., Wiesinger B., Hak J.B., Tielemans H., Ziemer G., Cristea E., Lansky A., Bérégi J.P. Sirolimus-eluting stents for the treatment of obstructive superficial femoral artery disease: six-months results. Circulation. 2002;106(12):1505-1509. PMID: 12234956. https://doi.org/10.1161/01.cir.0000029746.10018.36
- Scheinert D., Scheinert S., Sax J., Piorkowski C., Bräunlich S., Ulrich M., Biamino G., Schmidt A. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005;45(2):312-315. PMID: 15653033. https://doi.org/10.1016/j.jacc.2004.11.026
- Garcia L., Jaff M.R., Metzger C., Sedillo G., Pershad A., Zidar F., Patlola R., Wilkins R.G., Espinoza A., Iskander A., Khammar G.S., Khatib Y., Beasley R., Makam S., Kovach R., Kamat S., Leon L.R. Jr., Eaves W.B., Popma J.J., Mauri L., Donohoe D., Base C.C., Rosenfield K.; SUPERB Trial Investigators. Wire-interwoven nitinol stent outcome in the superficial femoraland proximal popliteal arteries: twelve-month results of the SUPERB Trial. Circ Cardiovasc Interv. 2015;8(5). pii: e000937. PMID: 25969545. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000937
- Garcia L.A., Rosenfield K.R., Metzger C.D., Zidar F., Pershad A., Popma J.J., Zaugg M., Jaff M.R.; SUPERB investigators. SUPERB final 3‐year outcomes using interwoven nitinol biomimetic supera stent. Catheter Cardiovasc Interv. 2017;89(7):1259-1267. PMID: 28471091. https://doi.org/10.1002/ccd.27058
- Laird J.R., Zeller T., Loewe C., Chamberlin J., Begg R., Schneider P.A., Nanjundappa A., Bunch F., Schultz S., Harlin S., Lansky A., Jaff M.R. Novel nitinol stent for lesions up to 24 cm in the superficial femoral and proximal popliteal arteries: 24-month results from the TIGRIS randomized trial. J Endovasc Ther. 2018;25(1):68-78. PMID: 29285955. https://doi.org/10.1177/1526602817749242
