Global Algorithm for the Endovascular Treatment of Chronic Femoropopliteal Lesions

Step 1: evaluate lesion morphology on preprocedural imaging (Duplex sonography and intravascular ultrasound) to select lesion preparation tools; lesions defined mainly by calcification, length, total occlusion and in-stent restenosis

Step 2: select vessel preparation (plain old balloon angioplasty, atherectomy, thrombectomy, intravascular lithotripsy, specialty balloons, or a combination) by lesion and patient-specific characteristics; Delphi consensus on appropriateness by lesion anatomy, length, plaque morphology and subintimal vs intraluminal guidewire crossing

Step 3: definitive lesion treatment with drug-coated balloons, bare-metal stents, drug-eluting stents and/or covered stents, or a combination