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reatment of disease in the superficial femoral artery (SFA) is particularly challenging because of the particular physiological and anatomical features of this vessel; it is the longest vessel in the region with the fewest side branches and subjected to unique geometrical forces, including flexion, torsion, elongation and compression. Although endovascular treatment (EVT) of SFA disease offers the advantages of being less invasive with low complication and mortality rates, it continues to be undermined by late clinical failure secondary to restenosis and occlusion. Traditionally, balloon angioplasty has been used in EVT of SFA disease, but long-term outcomes are less than ideal, with outcome deteriorating in proportion to lesion length.1 The latter limitations, which are the basis for the classical indication for EVT to treat only focal stenotic lesions, have fueled the search for improved patency and clinical outcomes, leading to the use of stenting for the treatment of SFA disease. Considerable advances over the past decade in the technology for EVT of SFA disease include the dramatic increase in the use of self-expandable nitinol stents, which have become the standard of care over stainless steel stents based on data from several nonrandomized studies.2,3 In 2007, the TASC document was revised, and treatment strategies based on lesion morphology were updated (Table 1) to reflect the increasing number of publications demonstrating favorable outcomes of EVT for occlusive SFA disease. However, choosing the ideal treatment strategy is made difficult by the paucity of well-controlled randomized trials, with the majority of studies being nonrandomized single-center studies with small populations. Furthermore, long-term follow-up to validate the durability and sustained efficacy of self-expandable nitinol stents has not been investigated extensively.

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