Above-Knee Arterial Occlusion Treatment - Femoropopliteal Artery

Above-knee arterial occlusion is the narrowing or blockage of the femoropopliteal artery segment due to atherosclerosis. This area is the most common location for peripheral artery disease.

Femoropopliteal Artery Anatomy

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The femoropopliteal segment is the longest artery segment of the leg and is subject to the most mechanical stress.

Anatomical Structure:

External Iliac Artery
        ↓
Common Femoral Artery
        ↓
     ┌──┴──┐
     ↓     ↓
  Deep      Superficial
 Femoral    Femoral Artery
(Profunda)      (SFA)
                 ↓
           Popliteal Artery
                 ↓
          ┌──────┼──────┐
          ↓      ↓      ↓
       Anterior Tibio-  Posterior
       Tibial  peroneal  Tibial

Segment Lengths:

• Superficial femoral artery (SFA): ~30-40 cm
• Popliteal artery: ~15-20 cm
• Total femoropopliteal segment: ~50 cm

Why Is the Femoropopliteal Region Most Affected?

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Mechanical Factors

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1. Adductor canal: The narrowest passage point for SFA
2. Flexion stress: Repeated trauma during knee bending
3. Long segment: Large surface area for atherosclerosis

Risk Factors

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Symptoms of Above-Knee Arterial Occlusion

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Fontaine Classification

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Typical Symptoms

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Claudication (Intermittent Limping):

• Calf or thigh pain while walking
• Improves in 2-5 minutes with rest
• Starts at a certain distance
• Earlier on slopes/stairs

Advanced Stage Symptoms:

• Night pain (decreases when leg is lowered)
• Cold feet
• Trophic changes (hair loss, nail thickening)
• Non-healing wounds

Diagnostic Methods

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Physical Examination

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• Femoral and popliteal pulse palpation
• ABI (Ankle-Brachial Index) measurement
• Capillary refill time

ABI Assessment:

Imaging

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Doppler Ultrasound:

• First-line test
• Non-invasive
• Flow velocities and stenosis degree

CT Angiography:

• Detailed anatomical map
• Calcification assessment
• Treatment planning

DSA (Digital Subtraction Angiography):

• Gold standard
• Treatment possible in same session

TASC II Classification (Femoropopliteal)

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Endovascular Treatment Options

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1. Balloon Angioplasty (PTA)

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Conventional Balloon:

• For short lesions
• Low cost
• Restenosis risk: 40-60% (1 year)

Drug-Coated Balloon (DCB):

• Paclitaxel or Sirolimus coated
• Prevents neointimal hyperplasia
• Restenosis risk: 15-25% (1 year)
• Preferred method

2. Stenting

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Self-Expanding Nitinol Stent:

• Long segment disease
• Flexibility advantage
• 1-year patency: 70-80%

Drug-Eluting Stent (DES):

• Best long-term results
• Low restenosis risk
• High cost

Interwoven Stent:

• New generation technology
• High fracture resistance
• Suitable for knee area

3. Atherectomy

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Plaque removal techniques:

4. Chronic Total Occlusion (CTO) Crossing

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Techniques:

• Antegrade approach (ipsilateral)
• Retrograde approach (from tibial arteries)
• Subintimal angioplasty (SAFARI technique)

Success rate: 80-95% (in experienced centers)

Treatment Algorithm

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Above-Knee Arterial Occlusion Diagnosis
                ↓
    Lifestyle modification + Medical therapy
                ↓
           Symptoms persist?
             ↙     ↘
          No       Yes
          ↓         ↓
       Follow    Lesion assessment
                      ↓
                ┌─────┼─────┐
                ↓     ↓     ↓
            <10 cm  10-25 cm  >25 cm
                ↓     ↓     ↓
             DCB   DCB/DES  Consider surgery

Treatment Outcomes

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Primary Patency Rates

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Clinical Improvement

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• Claudication distance: 2-4x increase
• Quality of life: Significant improvement
• Limb salvage: >95%

Complications and Management

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Early Complications

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Late Complications

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• Restenosis: Most common problem, reduced with DCB/DES
• Stent fracture: Especially in knee area
• Thrombosis: With antiplatelet non-compliance

Medical Treatment

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For All Patients

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• Aspirin: 100 mg/day (lifelong)
• Clopidogrel: 75 mg/day (at least 6 months)
• Statin: LDL <70 mg/dL target
• ACE inhibitor: Vascular protection
• Smoking cessation: Mandatory

Exercise Program

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• Supervised walking program
• 3 days per week, 30-45 minutes
• Walking to claudication threshold
• Significant benefit in 3-6 months

Surgical Treatment

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Indications

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• TASC D lesions
• Failed endovascular intervention
• Young, active patients (for long-term patency)

Surgical Options

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• Femoral-popliteal bypass: Saphenous vein or synthetic graft
• Femoral endarterectomy: Localized disease
• Hybrid procedure: Iliac stent + Femoral bypass

Follow-up Protocol

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Regular Checks

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Warning Signs

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• Decrease in walking distance
• New onset rest pain
• Coldness/color change in foot

Frequently Asked Questions

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Appointment and Contact

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To make an appointment for above-knee arterial occlusion evaluation and treatment:

📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul

📞 Phone: +90 212 665 50 50 (Ext: 4012)

This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.

Related Peripheral Interventions

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Other services related to above-knee arterial occlusion treatment:

• Below-Knee Arterial Occlusion - Infrapopliteal treatment
• Iliac Artery Treatment - Pelvic vessel treatment
• Peripheral Angiography - Vascular imaging
• Atherectomy - Plaque removal
• Peripheral Vascular Disease - Advanced treatment