Superficial Femoral Artery

Abbreviations. ALA, 5-aminolevulinic acid PDT, photodynamic treatment SFA, superficial femoral artery... 

Another drug, ALA, has been used to treat restenosis of the superficial femoral artery. These have been small, uncontrolled studies. In one report, ALA was given orally in a clinical study of adjuvant PDT in patients undergoing femoral angioplasty (61). Patients left the hospital after an overnight stay and there were no reports of skin photosensitivity. The authors suggested a benefit and no evident safety concerns, leading... 

Light can be administered in a variety of forms. There may be interesting opportunities to activate superficial arteries such as the carotid artery, superficial femoral artery (SFA), or an arteriovenous graft from outside the vessel lumen. This approach is limited by potential skin irritation and by loss of irradiance as the light traverses the near side vessel wall, causing "semi-lunar activation. 

Mansfield RJR, Jenkins MR Pai ML, et al, Long-term safety and efficacy of superficial femoral artery angioplasty with adjuvant photodynamic therapy to prevent restenosis, BrJ Surg 2002 89 1538-1539. 

Ansel GM, Silver MJ, Botti CFJr, et al. Functional and clinical outcomes of nitinol stenting with and without abeiximab for complex superficial femoral artery disease a randomized trial. Catheter Cardiovasc Interv 2006 67(2) 288-297. 

In the periphery, the siroUmus-coated cordis self-expandable stent (SIROCCO) trial, a randomized, donble-bhnd study comparing sirolimus eluting stents to nitinol bare metal stents in patients with chronic limb ischemia caused by superficial femoral artery occlusions or stenoses, reported no difference between drag elntmg and bare metal stents. Both stent types improved the arterial brachial indices and claudication symptoms, and both stent types demonstrated similarly low restenosis rates (22.9% for sirolimus eluting stents vs 21.1% for nitinol bare metal stents p>0.05)... 

Bastounis EA, Maltezos CK, Balas PE. Carotid endarterectomy and patch angioplasty, utilizing a segment of autogenous endarterectomized superficial femoral artery a case report. IntAngiol 1995 14(2) 209-13. 

Duda SH, Bosiers M, Lammer J, Scheinert D, Zeller T, Oliva V, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery long-term results from the SIROCCO trial. J Endovasc Titer 2006 13(6) 701-10. 

A 52-year-old man developed skin necrosis after he tried to give himself an intramuscular injection of diclofenac 75 mg but actually injected the drug into an arterial perforator branch of the superficial femoral artery. 

Volume rendering is helpful in displaying the anatomical situation, e.g. the length of stenoses in the superficial femoral artery, and is able to provide information about the therapeutic options. The upper part of the abdominal aorta, iliac and femoral arteries is displayed in VRT AP and oblique views. The popliteal and lower limb arteries are best displayed in VRT PA views. Because VRT provides three-dimensional information, it is not necessary to segment the bones from the arteries. A complete set of images can be produced within a short period of time and can be delivered shortly after scanning (Fig. 15.8). 

Fig. 25.5. Volume-rendered multi-detector row CT angiogram in a patient with blunt trauma to the left upper leg. Volume-rendered view shows an abrupt contrast material stop with irregular edge at the distal segment of the superficial femoral artery, which is laterally deviated, indicating arterial rupture (arrow). Image shows also a severely dislocated fracture of the femur shaft at the level of arterial interruption...

Fig. Anatomy and landmarks for cannulating the femoral vein. The femoral vein should be cannulated at or just above the inguinal crease. A low cannulation point should be avoided because there is an increased risk of puncturing the superficial femoral artery.

The main blood supply to osteosarcomas in the proximal femur arises from the femoral circumflex and branches of the deep femoral arteries. Frequently, the segment of the deep femoral artery proximal to the origin of the circumflex arteries is so short that a catheter in this position is unstable and may dislodge into the superficial femoral artery resulting in inadequate infusion. This is best avoided by placing the catheter tip in the external iliac segment (Fig. 9.16). 

There are three levels of occlusive disease in the lower limb arteries aortoiliac, femoropopliteal, and infrapopliteal disease. Disease confined to one level may be asymptomatic or it can present with intermittent claudication. The presence of two or three levels of disease are symptomatic, and patients usually present with severe claudication or rest pain. Three levels of disease are often seen in patients with skin damage and critical limb ischemia. Without an intervention most limbs with critical ischemia will be amputated within 1 year. In patients with diabetes mellitus the disease is usually confined in the infrapopliteal vessels. Such patients may develop critical limb ischemia with one level of disease because this is the most distal of the three. Usually, multiple stenoses and/or occlusions are found in at least two of the run-off arteries. Although it is known that atherosclerosis develops most often in bifurcations, in the lower extremities the most frequently involved site is the superficial femoral artery. Other common sites are the aortoiliac, iliac, femoral popliteal, and tibioperoneal trunk bifurcations. 

Fig. 4. Low amplitude waveform with absence of end diastolic velocity is common in patients with oecluded arterial segments above and below the segment under investigation. (A) Low amplitude and absence of end diastolic velocity in the superficial femoral artery in the mid-thigh in a patient with common iliac significant stenosis and distal superficial femoral artery occlusion. (B) Very low velocities and a monophasic waveform in the posterior tibial artery of a patient with multiple stenoses and occlusions proximal and distal to the site of measurement.

Labropoulos N, Volteas N, Giannoukas A, Kutoubi A Al, Wolfe J, Mansfield AO, Nicolaides AN. Early hemodynamic effects of percutaneous transluminal angioplasty in patients with superficial femoral artery disease. Vase Surg 1997 31 615-621. 

Fig. 1. (A) Pre-intervention angiography. There is significant atherosclerosis of both superficial femoral arteries (SFA) and a discrete 100% stenosis in the disal right SFA. This complete occlusion was felt to be the culprit for the disabling claudication in this 80-year-old woman.

Scheinert D, Scheinert S, Schmidt A, Braunlich S, Muniez-Devos D. Sirolimus-eluting stents in obstructions of the superficial femoral artery Long-term results of double-blind randomized trial (Sirocco trial) 2003. Circulation 2003 108 abstract 2753. 

Bergeron P. Pinot JJ, Poyen V, et al. Long-term results with the Palmaz stent in the superficial femoral artery. J Endovasc Surg 1995 2 161-167. 

Gray BH, Sullivan TM, Childs MB, et al. High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after suboptimal angioplasty. J Vase Surg 1997 25 74-83. 

In the setting of hemodynamic instability and undetectable extravasation from the pelvis on angiography, further investigation of other vessels including the lumbar branches, branches of the common femoral artery, superficial femoral artery, and profunda femoral artery should be performed. If there is potential for splenic, hepatic, or renal injury, these vessels should also be evaluated. If all other potential arterial sources have been excluded and the patient remains hemodynamically unstable, then empiric embolization of the internal iliac arteries may be performed. 

Kessel DO, Wijesinghe LD, Robertson I, Scott DJ, Raat H, Stockx L,Nevelsteen A (1999) Endovascular stent-grafts for superficial femoral artery disease results of 1-year followup. J Vase Interv Radiol 10 289-296... 

Gemmete JJ, Dasika N, Forauer AR, Cho K, Williams DM (2003) Successfril angioplasty of a superficial femoral artery stenosis caused by a suture-mediated closure device. Cardiovasc Intervent Radiol 26 410-412... 

US and Doppler techniques are accurate means to diagnose injuries to the femoral vessels in the groin. These usually occur as a result of iatrogenic procedures (arterial catheterization), but may also be involved in displaced fractures of the pubis and the femoral neck, crush injuries, blunt trauma and so forth. The most common site for arterial injuries is the common and proximal superficial femoral artery. The main complication is a pseudoaneurysm. Other less frequent complications include thrombosis, arteriovenous fistula, dissection, intimal flaps and perivascular hematoma. Pseudoaneurysms of the femoral artery follow a tear of the vessel wall followed by leakage of blood from the artery into the adjacent tissue and usually appear as pulsatile well-defined anechoic masses located closely to the artery (Fig. 12.41). Mural thrombus is often present and partially fills the pseudoaneurysm sac. Blood flow inside the pseudoaneurysm is typically swirling with alternating red and... 

Fig. 13.11a,b Adductor hiatus. Transverse a gray-scale and b color Doppler 12-5 MHz US images over the lower third of the medial thigh demonstrate the superficial femoral artery open arrowhead) and vein white arrowhead), and the saphenous nerve open arrow) which course underneath the aponeurosis white arrow) of the adductor magnus (AM). Note the sartorius muscle (Sa) which lies superficial to the femoral neurovascular bundle. The insert at the upper left of the figure indicates probe positioning... 

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