Advancements in aorto-iliac and femoral stenting

Thanks to its notable technical success, the endovascular treatment of peripheral arterial disease in recent years has seen a rapid development due to minor invasiveness to open surgery. For many years percutaneous transluminal angioplasty (PTA) had been considered the procedure of choice; more recently stenting has been proposed to improve technical success and long-term patency. Firstly, stenting was used only in PTA complications and failures (such as in the cases of dissections and recoils), so to obtain a further improvement of results and to reduce lengthy procedures and distal embolism rates, primary and direct stenting were proposed. Improvements in stent design and integrity, as well as experience of operators have dramatically widened indications for the endovascular approach, in particular stenting, in total aorto-iliac occlusions and complete total occlusions of the superficial femoral artery. The TASC recommendations are a helpful guide for the choice of correct therapeutic approach. Long-term results of endovascular treatment and durability with respect to surgical repair can still be acquired, but early data warrant considering a review of TASC recommendations, particularly regarding endovascular treatment of TASC C and D lesions and direct stenting.