The endovascular treatment of the femoropopliteal segment is the most frequent revascularization option in patients with peripheral arterial occlusive disease (PAOD)
however, the plain old balloon angioplasty has limitations, especially in complex and calcified lesions, and can lead to dissections and recoil. In order to improve the technical success and the efficacy of the endovascular treatment in complex, sometimes severely calcified or thrombotic lesions or also in lesions in mobile segments, a lesion preparation strategy before the actual lesion treatment is frequently applied. Lesion preparation methods include atherectomy, thrombectomy or intravascular lithotripsy. Through lesion preparation plaques and/or organized thrombi can be minimally invasively removed or calcium deposits can be even fragmented with low threshold barotrauma, without damaging the vessel wall. Subsequently, the definitive treatment of the lesion can be carried out using drug-coated balloons (DCB), bare metal stents (BMS), drug-eluting stents (DES) or a combination of these. Due to the heterogeneity of patient and lesion characteristics, no 'one fits all' strategy is so far available
however, the choice of the appropriate instruments should be carried out based on the patient and lesion characteristics present, whereby for the lesion-specific parameters the extent of the morphology and underlying pathology plays an important role.