1. Conflict of Interest Statement
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Physician Name
L Garcia
Company/Relationship
BostonScientific AdBoard (modest)
EV3 Research/AdBoard(modest)
Spectranetics AdBoard (unpaid)
Pathway Medical AdBoard (unpaid)
AngioSculpt AdBoard (unpaid)
Idev Research (modest)
Scion Cardiovascular Board of Directors
Arsenal Medical Equity shareholder
TissueGen Medical Equity shareholder

2. Lawrence A. Garcia, MD DISCLOSURES Consulting Fees
ev3, Inc., Spectranetics, Pathway Medical Technologies, Inc., Boston Scientific Corporation
Ownership Interest (Stocks, Stock Options or Other Ownership Interest)
Scion Cardio-Vascular, Arsenal Medical, TissueGen, Inc.

3. Rebuttal: The Gods Must Be Crazy!
Lawrence A. Garcia, MD
Chief, Section Interventional Cardiology
Co-Director, Vascular Medicine Program
Director, Interventional Cardiology Fellowship Program
St. Elizabeth’s Medical Center
Tuft’s University School of Medicine
Boston, MA

4. Infra-inguinal Intervention

5. Forces Exerted on the SFA
Unfavorable anatomy
Two bifurcations/articulations
Unique vessel forces
Diffuse disease
High incidence of occlusive disease
Extremly complex lesion morphologies
Competitive flow via PFA
Extension / Contraction 1.
Torsion 2.
Flexion 4.
Compression 3.

8. Nitinol Self-expanding stenting 2009 at 12 months
Here is the unmet need!
Resilient
Durability
Fem-Pac
Idev
Thunder
Absolute
Vibrant

9. So we have heard how these few studies mean we still lack an answer
How many times do we need to see the same re-hashed data in a meaningless fashion?
We need to re-think and save our money for new directions in infra-inguinal therapy.

10. ABSOLUTE 2-year
Clinically no difference from PTA versus endoprosthesis
Although patency benefit still present
Walking test in favor of stenting
Clinically how did this help?

11. When was an SFA lesion only 6 cm without calcification?
What should we do:
First throw out the current thoughts that stenting with current technology in short lesions needs further review
Second we rethink the process we are trying to treat
No longer should these studies be “cherry-picked” for the best lesions to treat
When was an SFA lesion only 6 cm without calcification?

12. Enough already?! We need to rethink the trial designs
An OPC with non-scientific endpoint is unfortunate
Goals of 30% restenosis is shameful
Clinically PTA alone is equivalent to an endoprosthesis at 2 years suggests the stenting approach of revascularization with the current technology is NOT the answer
Let’s agree to challenge ourselves to study clinically and anatomically relevant patient groups we see everyday in our practices to glean real scientific answers!