Cirugía endovascular del sector femoropoplíteo distal: perspectivas futuras

Aims. The aim of this paper is to outline the main lines of future research directed at improving the outcomes of endovascular revascularization of the femoral-popliteal and distal (FPD) sector. Development. The FPD sector is still a challenge for modern surgery. The different revascularization techniques are associated with high reocclusion rates and endovascular surgery does not escape this mediocre therapeutic scenario. Myointimal hyperplasia (MIH) is linked to restenosis and to theprogression of obstructive arterial disease itself. It is also the main physiopathological phenomenon responsible for the repeated failures of vascular repairs, especially in the FPD sector. As in years gone by, it seems as though future work will be partly directed towards reducing MIH with the use of new technologies as well as toward seeking to avoid a constant dependence. Adjunctive therapies such as brachytherapy and drug-eluting stents are seen as the first alternative. Yet, gene therapy and cell therapy aimed at angiogenetic processes appear to want to veer away from the seemingly insurmountable MIH. Conclusions. We are entering a stage of technological innovations combined with an increase in demand and enhanced endovascular experience. which traces a promising future for the revascularization of the FPD sector. The vascular surgeon will have to be attentive as well as active if these hopes are to become consolidated.