Femoropopliteal Interventions in the Claudicant Patient

The femoropopliteal (FP) segment is the most commonly involved compartment among atherosclerotic peripheral arterial disease (PAD). Stent placement for femoral popliteal disease has gained progressive attention. Several randomized controlled trials have compared percutaneous transluminal angioplasty (PTA) versus self-expanding nitinol stents in the femoral popliteal segment. Drug-coated balloons are an attractive alternative to drug-eluting stent (DES) as they can deliver an antiproliferative agent, which ameliorates the process of neointimal proliferation and leaves no stent behind. Cryoplasty therapy (cold balloon angioplasty) has been used as an effective primary strategy for limiting the incidence of dissection, vessel recoil, and subsequent intimal hyperplasia and restenosis associated with the endovascular dilation of atherosclerotic lesions in the peripheral vasculature. Atherectomy devices are designed to debulk and remove atherosclerotic plaque by cutting, pulverizing, or shaving with catheter-deliverable blades. Directional atherectomy involves the resection of the atherosclerotic plaque with a cutting device in the longitudinal plane.