## Anatomical Distribution of PAD Lesions **Key Point:** The superficial femoral artery (SFA) is the most frequently involved vessel in lower limb PAD, accounting for approximately 40–50% of all atherosclerotic lesions in the lower extremities. ### Why SFA is Most Common 1. **Hemodynamic factors** — The SFA experiences high shear stress and turbulent flow at the adductor canal, predisposing it to atherosclerotic plaque formation. 2. **Anatomical vulnerability** — The SFA is a long, relatively narrow vessel with multiple angulations, increasing susceptibility to intimal injury. 3. **Clinical prevalence** — SFA disease is the most common cause of claudication in the lower limbs. ### Distribution Pattern in PAD | Vessel | Frequency | Clinical Significance | | --- | --- | --- | | Superficial femoral artery | 40–50% | Most common; claudication | | Popliteal artery | 20–30% | Often associated with SFA disease | | Iliac artery | 15–25% | Associated with aortoiliac disease | | Tibial/peroneal arteries | 10–20% | Distal disease; critical limb ischemia | **Clinical Pearl:** SFA disease typically presents with claudication of the calf and thigh, whereas iliac disease causes hip and buttock claudication (Leriche syndrome when bilateral). **High-Yield:** The SFA-popliteal segment is the most common site for both atherosclerotic disease and intervention (angioplasty, stenting) in PAD. 
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