facilitate implementation of broad changes in the treatment paradigm of PAOD. Infrapopliteal vasculature The diameter similarities between infrapopliteal and coronary vessels make the use of DES in the BK vascular bed an intui- tive application. Feiring and colleagues (2004) were the ﬁrst to demonstrate the safety and utility of using coronary DES in the tibial vessels and paved the way for a more widespread application of DES for treating infrapopliteal disease. Based on the outcome of 4 independent investigator- intiated studies, the sirolimus-eluting Cypher® stent (Cordis, Miami, FL, USA) have been CE-marked for the BK indica- tion (Siablis et al 2005; Scheinert et al 2005; Bosiers et al 2006; Commeau et al 2006). Our own study (Bosiers et al 2006) evaluated the Cypher® stent for BK applications in 18 CLI patients (Rutherford 4 and 5) resulted in a 6-month limb salvage rate of 94.4% with an angiographic late lumen loss of only 0.38 mm in the surviving patients. Commeau and colleagues (2006) used SES to treat 30 consecutive patients with CLI (Rutherford category 3–6) and a minimum of 2 diseased infrapopliteal vessels. A limb salvage rate of 100% was achieved at a mean follow-up of 7.7 months, and all surviving patients treated with Cypher® stents had marked clinical improvement with 97% primary patency as measured by target lesion revascularization (Commeau et al 2006). Siablis and colleagues (2005) compared the outcome of 29 CLI patients treated with the sirolimus-eluting Cypher® stent with another 29 CLI patients receiving a BMS for infrapop- liteal revascularization. The 6-month primary patency rate was signiﬁcantly higher in the Cypher® group compared to the BMS group (92.0% and 68.1%, respectively, p 0.002) (Siablis et al 2005). Angiographic follow-up 6-months post index intervention revealed a binary in-stent restenosis of only 4.0% after Cypher® stent implantation, while the rate was as high as 55.3% after BMS implantion (p 0.001) (Siablis et al 2005). Siablis and colleagues (2007) also published their one-year follow-up results showing 86.4% primary patency in patients with DES, whereas patients with BMS had primary patency of 40.5% (p 0.001). Likewise, the binary in-stent restenosis was better with DES, 36.7% in the Cypher® stent group, and 78.6% in the BMS group (p 0.001). (Siablis et al 2007). The same highly signiﬁcant difference in 6-month angiographic outcome between the Cypher® and the nondrug-eluting BX Sonic® stent (Cordis, Miami, FL, USA) was conﬁrmed by Scheinert and colleagues (2006) in a nonrandomized controlled trial. The study evalu- ated 60 consecutive patients presenting with infrapopliteal Vascular Health and Risk Management 2008:4(3) DES in the management of PAD lesions. The binary restenosis rate was found to be 0% in the Cypher® arm and 56.5% in the control BMS arm (p 0.001) (Scheinert et al 2006). Feiring and Wesolowski (2007) recently proposed a new technique for combining antegrade popliteal arterial access with tibial DES implantation in patients with occluded SFA occlusions. Five patients scheduled for BK amputations, successfully received overlapping infrapopliteal DES via this approach. After a mean follow-up period of 29 months, no deaths, no amputations, and no TLR were recorded. (Feiring and Wesolowski 2007). The current generation DES used for BK interventions are balloon-expandable, which are known to be crushable. Stent crushing and fracturing may negatively inﬂuence stent performance and patient clinical outcome. To date, one case report of a fractured DES has been published (Scharzmaier-D’Assie et al 2007). The development of small vessel drug-eluting, self-expanding nitinol stents may improve the efﬁcacy of the current generation of DES because self-expanding nitinol stents are less prone to frac- tures when compared with balloon-expandable stents. This can be important if longer infrapopliteal lesions will start to be treated. Our group recently reported the 12-month results using the commercially available non-drug-eluting Xpert® (Abbott Vascular, Santa Clara, CA, USA) nitinol stent system in BK interventions. With a 12-month primary patency rate of 76.3%, and a limb salvage rate of 95.9%, the clinical outcome after bare metal nitinol stent implan- tation was remarkable. Moreover, 12-month angiography with quantative vessel analysis (QVA) on the 73% of patients available for follow-up in the cohort revealed an angiographic binary restenosis rate of only 20.5%, which is comparable with well accepted coronary DES study outcomes. We attributed this optimal performance in the infrapopliteal arteries to the maintenance of ﬂow dynamics because the stent was speciﬁcally designed for use in small vessels (Bosiers et al 2007). Although evidence currently indicates that the implantation of DES in the infrapopliteal vasculature leads to favorable outcomes with high mid-term primary patency and limb salvages rates, further support for the use of DES in patients with CLI and BK lesions will be gained from well-designed RCT. Such trials are about to start in conjunction with industry support. Renal arteries DES have also been applied for the treatment of renal artery stenosis, but as in the peripheral vascular bed, the number of publications remains sparse. Only 1 case report exists 555