Femoral stenting: what do the guidelines tell us

Recommendations in guidelines should reflect current knowledge due to results of well-designed randomized clinical trials. However, one of the main problems with guidelines concerning revascularization in patients with peripheral arterial disease (PAD) is the lack of such clinical trials with a paucity of so called level I data. Furthermore, vascular interventions are practiced by physicians with different medical, surgical and radiologic speciality training background. An inter-society consensus statement by its very nature coalesces into one document the divergent experiences, interests and also interpretation of the literature by the participating parties, in our case mainly vascular surgeons and non-surgical interventionists. Therefore the recommendations in such international multi-societal consensus documents--such as the TASC document--are a compromise due to the necessity to be accepted by the different societies. Therefore often it remains difficult to follow such recommendations in clinical routine. A major problem of all guidelines is the problem of contemporaneity so that recent developments often cannot be included or discussed. Furthermore, in international guidelines no acknowledgement can be made of country- and/or center-specific differences.