الفهرس 
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Abstract
This is a prospective study conducted on 55 patients presenting to the vascular surgery unit of Beni Suef University Hospitals between January 2020 and December 2021. The study group includes patients with symptomatic atherosclerotic occlusive disease of osteal segment of SFA.
The aim of this study was to evaluate the different endovascular techniques of management the SFA osteal lesions in cases with critical limb ischemia or incapacitating claudication regarding the feasibility, patency, clinical success, limb salvage rates and complications.
The available techniques of endovascular management include percutaneous intra-luminal and sub-intimal techniques. These techniques can effectively create a new flow channel within the SFA, bypassing the diseased segment entirely to the patent distal run off vessels.
Sub-intimal angioplasty is technically available, safe, and giving promising revascularization of the SFA with almost same results as intra-luminal angioplasty. Also, sub-intimal angioplasty are associated with significant decreasing in morbidities and mortalities. On the other hand, sub-intimal angioplasty are providing most CLI cases uniqueness limb salvage, marked long term patency rate and valuable decreasing of symptomatic recurrence. Due to all these findings, sub-intimal angioplasty is a preferable option by endovascular specialists to manage cases with long and/or calcified SFA lesions including osteal lesions.
Retrograde trans-popliteal or trans-pedal angioplasty procedures after failure of antegrade procedures for management of CLI cases due to osteal SFA lesions are now technically available, safe and effective. Technical results are promising. These procedures in some CLI cases may be the last available option for limb salvage. Many recent studies are reporting that mid-term and long term outcomes regarding the patency rate and amputations free survival after these procedures are marvelous.
Balloon angioplasty is the simplest technique and may be the first line of endovascular management with high primary patency results. Primary stenting during the endovascular management of the significant atherosclerotic lesions of the SFA is still controversial. No solid data can oscillate that primary stenting significantly improves the mid-term and long term outcomes. SFA is exposed to different external forces that make stenting not popular. However, stenting can improve the
outcomes in cases have intimal dissection, residual stenosis or recoil after proper balloon dilatation.
Recent advanced endovascular facilities like drug eluting balloons and flexible stents are giving us promising future outcomes in the management of these lesions.
Recurrence is not uncommon in PAD cases. The
lesions characteristics, associated comorbidities, the presence of stent and run off vessels are playing important role of rate of recurrence. Regular follow-up depending on clinical assessment and non-invasive arterial investigations is a cornerstone in the management plan.
This study should be performed on a wide range of cases in order to be able to examine the predictors of mid-term and long term outcomes of endovascular management of SFA osteal lesions.
Regular, strict, meticulous and longer follow up plans are required to survey the long term outcomes of endovascular management regarding feasibility, patency, technical success, clinical success, limb salvage rates and complications.