The femoropopliteal anatomy is often highlighted for the challenges it poses to achieving durable results in our efforts to treat peripheral vascular disease. It twists and turns and has calcifications, takeoffs, and landings that can thwart our best laid plans at any point during a case and certainly throughout follow-up. But, each of these challenges poses an opportunity for continued improvement if not innovation.

Although there has been progress in recent years—and significant headwinds—there remains ample opportunity for this field to evolve. Improvements will come in the form of techniques and technologies, but also in patient selection and follow-up. Enhancements in our imaging capabilities, access methods, and clinical trial endeavors will also be key.

With this in mind, we approached experts from around the globe and asked them to share the latest updates across a variety of developing spaces in above-the-knee interventions.

To open our feature, we have two pieces on intravascular ultrasound (IVUS) in superficial femoral artery (SFA) interventions. First, Ramya C. Mosarla, MD, and Eric A. Secemsky, MD, share evidence supporting the use of IVUS in SFA interventions, reviewing its impact on procedural outcomes, trial data, practice patterns, and more. Then, Richard B. Allan, BHlth Sc(Hons); Christopher L. Delaney, BMBS; and Phillip J. Puckridge, MBBS, detail a series of observations and suggestions for using IVUS in femoropopliteal intervention, specifically for guiding therapy preintervention and assessing efficacy of treatment.

We then move to status updates on paclitaxel and sirolimus. First, Peter A. Schneider, MD, shares lessons learned from long-term randomized controlled trial and registry data for paclitaxel-coated devices in femoropopliteal disease. Then, Edward T.C. Choke, MBBS, and Tjun Y. Tang, MBBChir(Cantab), outline where we are with sirolimus devices in SFA disease, including current device platforms and the clinical trial landscape.

In a discussion moderated by William A. Gray, MD, a global group of panelists, including Marianne Brodmann, MD; Manar Khashram, MBChB; Andrej Schmidt, MD; and Thomas Zeller, MD, share their thoughts on treatment of extreme femoropopliteal calcification.

Next, Michiel T. Voûte, MD, and Alexandra O. Stathis, BAdvSci(Hons), present an in-depth look at the DISFORM classification system for peripheral artery postangioplasty dissection, covering reporting standards and its use as a decision aid for when to treat those dissections.

Finally, we switch gears to a roundtable discussion moderated by Prof. Varcoe, who asks Venita Chandra, MD; Afshin Gangi, MD; Tara M. Mastracci, MD; and Parag J. Patel, MD, for their insights into the evolving landscape of meeting development in the vascular space.

Also included in this issue is an interview with pediatric interventional radiologist Alex M. Barnacle, BM, who discusses the rewarding and challenging aspects of a career in pediatric interventional radiology, including the fight for recognition of the field.

This issue also marks the 20th anniversary of Endovascular Today. The publishing team thanks you for reading, authoring, and supporting the endeavor and looks forward to future collaborations.

Andrew Holden, MBChB, FRANZCR, EBIR
Ramon Varcoe, MBBS, MS, FRACS, PhD, MMed(CliniEpi)
Guest Chief Medical Editors