The technical and clinical success rate of PTA of femoropopliteal artery stenoses in all series exceeds 95% . Device developments such as hydrophilic guide wires and technical developments, such as subintimal recanalization, provide high recanalization rates in total occlusions of more than 85%. The technique of subintimal angioplasty is not as dependent on length, but rather on the presence of normal vessel above and below the occlusion to allow access.

Stents have been designed to improve the technical success rate and overall arterial patency after peripheral transluminal angioplasty (PTA). By fixing arterial plaque against the arterial tree, stents prevent immediately recoil and obstructive plaque dissection. However, there is a tendency for loss of initial patency due to restenosis (which usually occurs in the first six months) or to progressive atherosclerosis at the lesion site or elsewhere in the same vessel. The smaller vessel diameter is probably the major explanation for the higher rate of restenosis compared to iliac disease.

Previous small randomized trials failed to demonstrate the superiority of PTA plus stent over PTA alone in the femoro-popliteal tree. The largest randomized trial. comparing PTA alone versus PTA plus stent (Palmaz, stainless steel stent) in the superficial femoral artery in 227 patients showed that stent use was required in 15% of the PTA-alone group; and 1-year angiographic restenosis was not statistically different between PTA alone and PTA plus stent (32.3% vs. 34.7%, p=0.85). Survival was not different between the PTA alone group and PTA plus stent at 4 years. Therefore, the use of stents was not supported by previous data. Stents may have a role in salvaging acute PTA failure or complications.

Recently, patency at one year improved significantly with development of nitinol stents (ex. Smart stent, Dynalink stent, Expander stent). The several studies using Smart stent achieved one-year patency in 83%-88% of cases. The use of nitinol stents has reported 3-year patency rates of up to 76%. In nonrandomized one study comparing nitinol and stainless stent implantation for femoro-popliteal artery showed that cumulative patency rates at 6, 12, 24 months were 85%, 75%, and 69%, respectively, after nitinol stent implantation verus 78%, 54%, 34%, respectively after stainless steel stent implantation (p=0.008). This results suggested that primary placement of nitinol stents might be more effective than conventional balloon angioplasty.

Recently, in a meta-analysis of randomized controlled trials, currently available data suggest no significant difference in the rate of TVR between PTA with provisional stenting and routine stenting for symptomatic patients with short SFPA lesions, although there is a trend for lower restenosis and a significant higher immediate technical success rate in favour of routine stenting as well as a non-significant trend towards lower TVR with the newer generation nitinol stents.

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