Chronic Total Occlusion of Superficial Femoral Artery

A chronic total occlusion (CTO) of the superficial femoral artery (SFA) is a complete, long-standing blockage of this major artery in the thigh. It causes significantly reduced blood flow to the lower leg and is a common cause of severe intermittent claudication and critical limb ischaemia.

Treatment options include endovascular techniques such as angioplasty, stenting, or drug-eluting balloon angioplasty, or open surgical bypass. Modern endovascular tools and techniques have significantly expanded the ability to treat long and complex SFA occlusions with good results and minimal recovery time.

The most common symptom is calf pain or cramping with walking (claudication) that is relieved by rest. More severe occlusion can cause rest pain, coldness, pallor or discolouration of the foot, and non-healing wounds, indicating critical limb ischaemia requiring urgent treatment.

CT angiography or MR angiography provides detailed information about the location and extent of the occlusion and the quality of the vessels above and below. This information is used to plan the most appropriate endovascular or surgical approach for each patient.

With appropriate treatment, most patients experience significant improvement in walking distance and symptoms. Long-term outcomes depend on the treatment used, the extent of disease, and ongoing management of cardiovascular risk factors including smoking cessation and exercise.