The challenges posed by the femoropopliteal vessels are well documented, with each segment bringing its own unique considerations. As operators, we must understand the potential pitfalls associated with each possible therapy before selecting the option best suited to the patient’s lesion, anatomy, comorbidities, and lifestyle needs. Adding to the difficulty is the sentiment that the patients and lesions comprising the available data do not reflect those seen in everyday practices, with the latter more often characterized by the exclusion criteria of most studies. Patients with multiple comorbidities, extensive multilevel disease, common femoral involvement, calcification, access challenges, and lifestyle limitations are the norm in many practices. On the other end of the spectrum, patients who are relatively healthy but have some degree of claudication must still be carefully considered to ensure their postprocedural outcome is not more severe than their presentation. And of course, for the last several years, the lower extremity revascularization field has been in the shadow of a safety signal related to some of its most frequently used devices.

Therapies and studies aimed at addressing these needs continue to emerge and evolve, with new data presented at every congress. In this edition, we aim to explore the applicability of these modalities and their data, inviting expert voices to share their opinions and perspectives.

To open our feature, Drs. Anna Krawisz and Eric Secemsky summarize the key studies and findings conducted to explore paclitaxel safety and the degree to which potential late mortality concerns have been adequately addressed. Continuing this discussion, Gary Ansel, MD, interviews representatives from the FDA regarding the regulation of paclitaxel devices and what the agency needs to see in order to update its safety statement. Next, Sahil A. Parikh, MD, and Navneet Sharma, MD, review the various methods of vascular drug delivery—past, present, and potential.

Yousif Al-Saiegh, MD, and William A. Gray, MD, then provide an update on one of the more common confounders of our best-laid plans—vascular calcification. The authors discuss the impact of calcification on therapeutic applicability and efficacy, as well as results to date with devices aimed at improving historic outcomes. Next we have the first of two panels diving into commonly encountered challenges, with Dr. Ramon L. Varcoe moderating a session including perspectives on outcomes in TASC C & D lesions. Drs. Herbert D. Aronow, Darren B. Schneider, and Sabine Steiner weigh in on the available data and how they approach patients presenting with severe disease. Wrapping up our feature, we have a deep-dive discussion on common femoral artery disease, moderated by Peter A. Schneider, MD, who poses questions to Drs. Daniela Branzan, Daniel Clair, Tony Das, and Yann Gouëffic on how they view endovascular options in cases when open surgery remains the first choice for many operators.

Outside of our feature on femoropopliteal disease, the editors have compiled key industry news, literature highlights, and an in-depth interview with vascular surgeon Anna Prent. Miss Prent discusses her career path, risk-stratification and tailoring therapies to patient needs, caring for COVID patients in a London intensive care unit, and the importance of prioritizing one’s life outside of the hospital.

We hope you find these articles as insightful as we have, and we are profoundly grateful for the time and effort the authors and panelists have put forth in sharing their experiences.

Marianne Brodmann, MD
Ehrin J. Armstrong, MD, MSc, MAS, FACC, FSCAI, FSVM
Guest Chief Medical Editors