A 58-year-old man with a history of hypertension and dyslipidaemia presents with intermittent claudication of the right calf at 100 metres. ABPI of the right leg is 0.62. Duplex ultrasound shows a significant stenosis at the right superficial femoral artery (SFA) in Hunter's canal. His symptoms have not responded to 3 months of supervised exercise therapy. What is the most appropriate intervention?
- A Femoropopliteal bypass with saphenous vein graft
- B Percutaneous transluminal angioplasty (PTA) with or without stenting of the SFA lesion ✓
- C Lumbar sympathectomy
- D Prostaglandin infusion (iloprost) therapy
Explanation
For lifestyle-limiting claudication that has failed supervised exercise therapy, a focal stenosis of the SFA is best treated by endovascular intervention — percutaneous transluminal angioplasty (PTA) +/- stenting — as first-line revascularisation. This is safe, minimally invasive, and effective for short-segment SFA disease. Surgical femoropopliteal bypass is reserved for long-segment occlusions, failed endovascular treatment, or critical limb ischaemia; it carries higher morbidity and is not first-line for claudication. Lumbar sympathectomy has very limited evidence for claudication. Prostaglandin infusions are used in critical limb ischaemia when revascularisation is not possible.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.