Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions: An Interdisciplinary Expert Opinion Statement
- PMID: 40074516
- DOI: 10.1016/j.jcin.2024.11.038
Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions: An Interdisciplinary Expert Opinion Statement
Abstract
A global treatment algorithm was developed for the endovascular revascularization of femoropopliteal lesions and chronic total occlusions, aiming toward a more standardized approach to endovascular treatment in patients with peripheral artery disease. The following steps are proposed. 1) Evaluation of lesion morphology based on preprocedural imaging by Duplex sonography and intravenous ultrasound for selection of lesion preparation tools. Lesion characteristics are mainly defined by calcification, lesion length, and the presence of total occlusion and in-stent restenosis. 2) Selection of vessel preparation strategies, which encompass plain old balloon angioplasty, atherectomy, thrombectomy, intravascular lithotripsy and specialty balloons, or a combination of the preceding, based on lesion and patient-specific characteristics. In addition, a Delphi consensus was applied for the appropriateness of lesion preparation strategies, depending on lesion anatomy, length, plaque morphology, and subintimal versus intraluminal guidewire crossing. 3) Definitive lesion treatment strategies using drug-coated balloons, bare-metal stents, drug-eluting stents, and/or covered stents or a combination. By establishing this treatment algorithm in routine practice, improvements in vessel- and patient-specific outcomes are anticipated, which will be further enhanced by continuous collaboration among experts from different countries and disciplines and by randomized controlled trials.
Keywords: atherectomy; balloon angioplasty; chronic femoropopliteal lesions; drug-coated balloons; endovascular repair; infrainguinal; lesion preparation; self-expanding stent(s).
Copyright © 2025. Published by Elsevier Inc.
Conflict of interest statement
Funding Support and Author Disclosures Dr Schmidt is a consultant for Abbott, Cook Medical, Reflow Medical, and Upstream Peripheral. Dr Rammos has received honoraria from Avinger, Biotronik, BD Bard, Cordis, Daiichi-Sankyo, Inari, Novartis, Shockwave, and Veryan; has consulted for BD Bard, Boston Scientific Corp, Veryan, and Shockwave; and has received institutional grants for research, clinical trial, or drug studies from Avinger, Biotronik, Boston Scientific Corp, Veryan, and Med Alliance. Dr Böckler has received honoraria from Abbott Vascular, Artivion, Cook Medical, Medtronic, Getinge, Philips, and W.L. Gore & Associates; and has consulted for Artivion, Brainlab, Cook Medical, DSMB, Siemens Healthineers, and W.L. Gore & Associates. Dr Blessing has received speaker honoraria from Cardinal Health, Abbott Vascular, Philips, Biotronik, Boston Scientific Corp, Medtronic, Terumo, and Shockwave. Dr Secemsky has received funding from the National Institutes of Health/NHLBIK23HL150290, Food and Drug Administration, and SCAI; received grants to institution from Abbott, BD Bard, Boston Scientific Corp, Cook, Medtronic, and Philips; and received speaking/consulting fees from Abbott, Becton Dickinson, BMS, Boston Scientific, Cagent, Conavi, Cook, Cordis, InfraRedx, Medtronic, Philips, Recor, Shockwave, Terumo, and VentureMed. Dr Grözinger received speaker honoraria from Abbott, Biotronik, and Siemens; and has consulted for Terumo and Cordis. Dr Korosoglou received modest speaker honoraria from Philips, Cordis, Boston Scientific Corp, and Bard Peripheral Vascular Inc; and institutional grants from Philips and Bard Peripheral Vascular Inc. Dr Patrone has consulted for Abbott, Asahi, BD, Shockwave, and Terumo. Dr Lichtenberg has received honoraria from Abbott Vascular, BD Bard, Medalliance, Biotronik, Boston Scientific Corp, Cook Medical, Medtronic, Philips, Shockwave, Veryan, Limflow, Biotronik, Cordis CSI, Penumbra, and Cardionovum; has consulted for CSI, W.L. Gore & Associates, Medtronic, Veryan, Philips-Intact Vascular, Shockwave, Bayer, Vesper Medical, Cagent Vascular, Cordis, Medalliance, Reflow Medical, and Bolt Medical; and has received institutional grants for research, clinical trial, or drug studies from Bard Peripheral Vascular, Veryan, Biotronik, Philips, Terumo, Med Alliance, Intact Vascular, Surmodics, Reflow Medical, and Cardionovum. Dr Langhoff has lectured, received research grants, or is a consultant for Abbott Vascular, Alvimedica, BD Bard, Boston Scientific Corp, Biotronik, B.Braun, Contego Medical, Cardionovum, iVascular, Medtronic, and Terumo. Dr Varcoe received modest consultant fees from Abbott Vascular, Cook Medical, Boston Scientific Corp, Philips, W.L. Gore & Associates, BD Bard, Medtronic, Nectero, Intervene, R3 Vascular, Alucent, Vesteck, and Surmodics; and has equity interests in EBR Systems, Vesteck, and Provisio Medical. Dr Zeller has received honoraria from Abbott Vascular, Biotronik, Boston Scientific Corp, Cook Medical, W.L. Gore & Associates, Medtronic, Philips-Spectranetics, Shockwave, and Veryan; consulted for Boston Scientific Corp, CSI, W.L. Gore & Associates, Medtronic, Veryan, Philips-Intact Vascular, Shockwave, Bayer, Vesper Medical, VentureMed, and ANT; and received institutional grants for research, clinical trial, or drug studies from Bard Peripheral Vascular, Veryan, Biotronik, Cook Medical, W.L. Gore & Associates, Medtronic, Philips, Terumo, TriReme, Shockwave, Med Alliance, Intact Vascular, B. Braun, CSI, Boston Scientific, University of Jena, Pluristem, PQ Bypass, Surmodics, Reflow Medical, and Ablative Solutions. Dr Stavroulakis has consulted for Phillips, Shockwave, Boston Scientific Corp, and Terumo; and received honoraria from Medtronic, Bentley, BD, and Biotronik. Dr Soukas has received institutional research funding from Bard, Boston Scientific Corp, Contego Medical, Cordis, Endologix, LInspireMD, LimFlow, National Institutes of Health, Penumbra, Philips, Reflow Medical, Reva Medical, Shockwave Medical, Soundbite, Surmodics, and W.L. Gore & Associates; and has been a consultant to AngioSafe, Boston Scientific Corp, Endologix, Shockwave Medical, and W.L. Gore & Associates. Dr Behrendt has reported that he has no relationships relevant to the contents of this paper to disclose.
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