Lower Limb Artery Angioplasty / Stenting

Background and indications

Percutaneous transluminal angioplasty (PTA) with or without stenting of lower extremity arteries is the endovascular treatment for peripheral arterial disease (PAD). It is indicated for stenoses and occlusions of iliac, femoral, popliteal, and tibial arteries causing disabling claudication (Fontaine stage IIb) or critical limb ischemia (stages III-IV: rest pain, trophic disorders, gangrene).

Angioplasty is first-line treatment for TASC A and B lesions. For more complex lesions (TASC C-D), it may be offered as an alternative to surgical bypass in high-risk patients.

Pre-procedure assessment

Assessment includes arterial Doppler ultrasound of lower extremities (ABI - ankle-brachial index), CT or MR angiography (lesion mapping), cardiovascular workup (ECG, echocardiography if needed), and risk factor optimization (smoking cessation, antiplatelet therapy, statin).

Procedure

Under local anesthesia and sedation, femoral arterial puncture (or radial/brachial depending on lesion location) is performed. Under fluoroscopic guidance, a guidewire is crossed through the stenosis or occlusion. Angioplasty is performed by balloon inflation. For iliac arteries, stenting (self-expanding or balloon-mounted) is nearly systematic. For superficial femoral arteries, drug-coated balloons (DCB, paclitaxel) reduce restenosis. For severe calcifications, atherectomy may precede ballooning. The procedure takes 1 to 2 hours.

Results and scientific evidence

For iliac lesions, 5-year primary patency rate is 80-90% after stenting. For superficial femoral artery lesions, drug-coated balloons offer 80-85% 12-month primary patency versus 55-65% for standard balloons (Tepe et al., The Lancet, 2015; DOI: 10.1016/S0140-6736(15)60500-1). The IN.PACT SFA trial confirmed DCB superiority at 5 years. For critical limb ischemia, limb salvage is achieved in 75-85% of cases.

Risks and complications

Access site hematoma (5-10%), arterial dissection (3-5%, treated by stenting), distal embolization (2-3%), acute thrombosis (< 2%), arterial perforation (< 1%). Major complication rate requiring surgery is 1-3%.

Recovery

1-2 night hospitalization. Dual antiplatelet therapy for 1-3 months then single agent long-term. Control Doppler ultrasound at 1, 6, and 12 months then annually.

Practical information

The procedure is performed as a short inpatient stay or outpatient depending on the case. It is performed by a vascular interventional radiologist, in coordination with the angiologist and vascular surgeon.