Peter A. Schneider, MD

It has been a stimulating and provocative past 12 months in our field of peripheral vascular care. As new trials begin to test the next generation of therapeutic advances above and below the knee, data continue to be presented and debated across device classes, with new insights emerging into medical management strategies and long-term patient well-being. As we weigh the benefits and risks of each therapy and match them to our patients’ unique needs, we must also keep in mind the importance of efficient care delivery, from screening and optimal medical/exercise management through their procedures to the coordination of after care. Improved metrics only matter if the care reaches the patient and they continue well beyond the day of their case.

In this month’s edition of Endovascular Today, we have brought together leading experts to share the current state of the art in peripheral artery disease (PAD), their informed opinions on current data, real-world practice pressures and patient needs, and their algorithmic approaches to putting it all together.

William P. Robinson III, MD, and Lakshmi Dwivedi, MBBS, open our issue with a piece on endpoint selection for PAD trials, promoting a multidimensional approach that reflects the patient’s clinical presentation, anatomic distribution of disease, and outcomes that meaningfully capture treatment success and patient benefit.

We assembled a global panel to explore how emerging data and devices are shaping modern drug-eluting therapy for PAD care above and below the knee. Osamu Iida, MD; Joakim Nordanstig, MD; Sahil A. Parikh, MD; Eric A. Secemsky, MD; and Sabine Steiner, MD, discuss device decision-making, opportunities and limitations for drug-coated technologies in the coming years, and how their practices have interpreted the findings of recent trials and the updated guideline recommendations.

Next up, Natasha Hasemaki, MD; Yassine Haddad, MD; and Konstantinos Stavroulakis, MD, present a deep dive into the hot topic and evolving role of vessel preparation in lower extremity revascularization: the available strategies, patient and lesion selection insights, persistent evidence gaps, and unmet needs.

Koen R. Deloose, MD, presents a practical approach to treatment decision-making for common femoral artery disease, reviewing evidence for open and endovascular treatment, contemporary endovascular strategies, and a practical algorithm for treatment selection based on patient and lesion characteristics.

Capping off our lower extremity revascularization issue is an article by Lena E. Tran, MD, and Joshua A. Beckman, MD, on the shifting paradigm in medical management of PAD. They walk us through lipid-lowering, antithrombotic, and cardiometabolic therapies, as well as the growing emphasis on comprehensive, guideline-directed care.

Finally, we close this issue with a profile on Dimitrios K. Filippiadis, MD. The interventional radiologist from University of Athens offers insights on image-guided pain management, advances in spine intervention, education, and the importance of standardized complication reporting.

I am grateful for the many hours our authors and panelists have given to this edition of Endovascular Today. It remains vital to our field that we make time to share your experiences and views and keep each other informed. We look forward to continuing this discussion in the months ahead and welcome your feedback.

Peter A. Schneider, MD
Guest Chief Medical Editor