Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions: An Interdisciplinary Expert Opinion Statement (JACC Cardiovascular Interventions March 2025)-Article: Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions: An Interdisciplinary Expert Opinion Statement

Article: Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions: An Interdisciplinary Expert Opinion Statement

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The document outlines a global algorithm developed for the endovascular revascularization of chronic femoropopliteal lesions, aiming to standardize treatment approaches in patients with peripheral artery disease. The process includes three primary steps: firstly, evaluating the lesion morphology through preprocedural imaging like Duplex sonography and intravenous ultrasound, which helps in selecting lesion preparation tools based on characteristics like calcification, lesion length, and total occlusions. Secondly, it involves selecting vessel preparation strategies, informed by lesion and patient-specific characteristics, which may include plain old balloon angioplasty, atherectomy, thrombectomy, and others. A Delphi consensus also informs the appropriateness of these strategies based on anatomy and plaque morphology. Finally, the definitive lesion treatment might use drug-coated balloons, bare-metal stents, or other stents in combination.<br /><br />The algorithm aims to improve outcomes by establishing a more systematic approach to treatment and encourages ongoing expert collaboration and randomized controlled trials for continued advancement. Key considerations also include various lesion preparation and treatment strategies such as drug-coated balloons (DCB) and atherectomy. The document notes the emerging use of intravascular lithotripsy (IVL) and addresses consensus needs, emphasizing the significance of evidence and expert agreement in leveraging these approaches.<br /><br />Though considerable progress is noted in understanding device performance and potential outcomes of endovascular procedures, continuous research is needed, as reflected in differing approaches for specific lesion or patient characteristics. Essentially, the document underscores the collaborative, multidisciplinary efforts required to optimize treatment for chronic femoropopliteal lesions and the need for continued clinical trials to enhance approaches in this therapeutically challenging area.

Keywords

endovascular revascularization

chronic femoropopliteal lesions

peripheral artery disease

lesion morphology

vessel preparation strategies

Delphi consensus

drug-coated balloons

intravascular lithotripsy

multidisciplinary efforts

clinical trials