Direct Stenting in Long Femoropopliteal Lesions

Endovascular treatment strategies for the relief of symptomatic lower extremity PVD secondary to femoropopliteal (FP) artery disease are changing at an unprecedented fast rate. Improved metallic stent designs, novel devices and techniques, and improvements to past therapeutic concepts have recently emerged, providing new and challenging options to the mainstay of percutaneous transluminal angioplasty (PTA) and surgery. The emergence of these new therapies has unequivocally brought with it contention and controversy; much of this debate is borne of the strong desire held by many to see data that compare the new treatment options to existing therapies. PTA is considered by its proponents to be the endovascular FP disease treatment by which all new technology must be judged. PTA should in fact be the first line of therapy for some focal, uncomplicated lesions. However, for long and complex lesions, newer nitinol self-expanding metallic stents have to date yielded results that are challenging PTA to garner the proclaimed title of “gold standard.”