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

Grigorios Korosoglou1, Andrej Schmidt2, Michael Lichtenberg3

  • 1GRN Hospital Weinheim, Cardiology and Vascular Medicine, Weinheim, Germany.

JACC. Cardiovascular Interventions
|March 12, 2025
PubMed

Insights

A new global algorithm standardizes endovascular treatment for femoropopliteal lesions and chronic total occlusions in peripheral artery disease patients. This approach optimizes lesion preparation and definitive treatment for improved outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Peripheral artery disease (PAD) affects millions globally, necessitating effective treatment for femoropopliteal lesions and chronic total occlusions.
  • Current endovascular revascularization approaches lack standardization, potentially impacting patient outcomes.
  • A need exists for a structured, evidence-based algorithm to guide treatment decisions.

Purpose of the Study:

  • To develop and propose a global treatment algorithm for endovascular revascularization of femoropopliteal lesions and chronic total occlusions.
  • To standardize the approach to endovascular treatment in patients with PAD.
  • To improve vessel- and patient-specific outcomes through a systematic treatment strategy.

Main Methods:

  • Lesion morphology evaluation using preprocedural Duplex sonography and intravascular ultrasound to assess calcification, length, and occlusion status.
  • Selection of vessel preparation strategies (e.g., angioplasty, atherectomy, lithotripsy) based on lesion characteristics and Delphi consensus.
  • Definitive treatment selection including drug-coated balloons, various stent types, or combination therapies.

Main Results:

  • The proposed algorithm integrates lesion evaluation, vessel preparation, and definitive treatment selection.
  • It incorporates advanced imaging and a range of endovascular tools for tailored patient care.
  • A Delphi consensus guided the appropriateness of lesion preparation strategies.

Conclusions:

  • Implementation of this standardized treatment algorithm is anticipated to enhance outcomes in PAD patients undergoing endovascular revascularization.
  • Continuous expert collaboration and further randomized controlled trials are crucial for validating and refining the algorithm.
  • This systematic approach aims to optimize the management of complex femoropopliteal disease.

Keywords:
atherectomyballoon angioplastychronic femoropopliteal lesionsdrug-coated balloonsendovascular repairinfrainguinallesion preparationself-expanding stent(s)

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