With well-documented pathologic and biomechanical obstacles, the superficial femoral (SFA) and popliteal arterial segments have long been viewed as among the most challenging—yet prevalent—sites for peripheral intervention. In addition to these difficulties and their effects on long-term outcomes, femoropopliteal intervention faces new headwinds. Numerous device options have emerged, established sufficient data to gain regulatory approvals in many markets around the world, and are in regular use. However, our understanding of both cost-effectiveness and comparative effectiveness is still limited. These are the key questions that clinicians and payors increasingly want to see answered, although the means to do so may pose the most significant SFA challenge yet. In this edition, we have asked experts from around the world to share their perspectives on the data we need to guide to tomorrow’s decision making.

In this issue, Mehdi Shishehbor, DO, discusses the challenges of applying current data from femoropopliteal studies in a real-world setting and improvements in concept and trial design that could guide evidence-based decision making in the future. We follow with a question posed to our expert panelists on what SFA trials they would like to see, including the key data needs, optimal designs, and likelihood that the studies will be undertaken.

Adam C. Salisbury, MD, and David J. Cohen, MD, then review the basic concepts of economic evaluation of medical devices, with a focus on applying these analyses to lower extremity revascularization procedures. Konstantinos Katsanos, MSc, MD, continues the discussion on the economic impact of medical devices with his article on cost-effectiveness analysis of drug-eluting stents and drug-coated balloons specific to a single-payor system. Next, a second group of expert panelists discusses how long the era of drug-eluting technologies will last and what will come next. Juan F. Granada, MD, provides his perspective on the current climate of preclinical research in SFA therapy, lessons learned in evaluating drug-eluting technologies, and what the future holds for pathology and preclinical testing. Constantino S. Peña, MD, concludes this issue of Endovascular Today with a look at the future of lower extremity imaging over the next 5 years.

John R. Laird, MD
Chief Medical Editor

Fabrizio Fanelli, MD, EBIR
Guest Chief Medical Editor