Polling Station

Poll 01/07/2018 – 31/07/2018

Filiform SFA stenosis – best treatment strategy

Question #1

How do you define this lesion based on TASC II Classification?

  • TASC A

  • TASC B

  • TASC C

  • TASC D

The expert: Prof. Fabrizio Fanelli, MD, EBIR
This lesion shows multiple stenoses > 15cm, thus it is a TASC C lesion
Question #2

In case, of endovascular treatment: Which would be your access vessel?

  • Antegrade (Right CFA)

  • Retrograde (Left CFA Up and Over)

  • Transbrachial

  • Tibial

The expert: Prof. Fabrizio Fanelli, MD, EBIR
There is not enough space to do an antegrade puncture, because the lesion starts already at the origin of the SFA.
Question #3

Which wire would you use?

  • .014

  • .018

  • .035

The expert: Prof. Fabrizio Fanelli, MD, EBIR
I would use a .035 hydrophilic wire with angled tip and standard body. This wire provides an excellent support with goof profile. It also has high torquability to be navigated through such a filiform lumen.
Question #4

Which would be your treatment strategy, if you had all devices available without any costs issues in your institution?

  • PTA as standalone therapy

  • PTA + (Drug Coated Balloon) DCB +/- Bare Metal Stent (BMS)

  • Debulking/atherectomy + DCB

  • Primary BMS

  • Primary stent-graft

  • PTA + DCB + Spot stenting

  • Primary (Drug eluting stent) DES

  • Scoring balloon + DCB +/- BMS

The expert: Prof. Fabrizio Fanelli, MD, EBIR
This is a long severe stenosis with flush occlusion on the proximal segment and no presence of calcium. I would keep the option of provisional stenting in the proximal portion because the profunda femoral artery should not be compromised by angioplasty.
Question #5

Which would be your treatment strategy, based on your currently available devices and reimbursement?

  • PTA as standalone therapy

  • PTA + DCB +/- Stent

  • Debulking/atherectomy + DCB

  • Primary BMS

  • Primary Stent-graft

  • PTA + DCB + Spot stenting

  • Primary DES

  • Scoring balloon + DCB +/- BMS

The expert: Prof. Fabrizio Fanelli, MD, EBIR
This treatment strategy represents the treatment of choice in order to achieve longer patency and consequently an economical benefit.
Question #6

What do you understand under the term vessel preparation?

  • I prepare the vessel to stay open

  • I prepare the vessel for a future bypass anastomosis

  • I prepare the vessel in order to completely remove the plaque

  • I prepare the vessel in order to modify the plaque prior to paclitaxel delivery or stent deployment

The expert: Prof. Fabrizio Fanelli, MD, EBIR
There is not yet a consensus on this definition but we know that DCB and also stent work better if a pre-dilation has been performed. In case of complex plaque morphology (especially calcium) scoring balloon or atherectomy can improve the drug uptake.
Question #7

Do you believe on the leave nothing behind concept?

  • Yes

  • No

The expert: Prof. Fabrizio Fanelli, MD, EBIR
It is well known that in-stent restenosis is more challenging than a restenotic lesion in a native vessel. Moreover we can keep open any surgical option.
Question #8

Are you using drug-eluting stents in the SFA?

  • Yes

  • No

The expert: Prof. Fabrizio Fanelli, MD, EBIR
I prefer to use DES in case of complex SFA lesions with circumferential calcification