An update on vessel preparation in lower limb arterial intervention
Abstract Background Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2020-11-01
|
| Series: | CVIR Endovascular |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42155-020-00175-6 |
| _version_ | 1819107484985458688 |
|---|---|
| author | William Ormiston Shelagh Dyer-Hartnett Rukshan Fernando Andrew Holden |
| author_facet | William Ormiston Shelagh Dyer-Hartnett Rukshan Fernando Andrew Holden |
| author_sort | William Ormiston |
| collection | DOAJ |
| description | Abstract Background Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim to give an overview of some of the devices currently available, or under investigation, for vessel preparation in the lower limb. Main text Vessel preparation devices include those that remove plaque (atherectomy devices) and those that modify plaque. The four groups of plaque removing atherectomy devices are defined by their plaque removal method: Directional, rotational orbital and excimer laser are categories of devices investigated for plaque modification. Intravascular lithotripsy devices generate sonic pulsatile pressure waves that pass into the vessel wall cracking calcified plaques whilst sparing soft tissue. This enables dilatation of calcified lesions at low pressure by conventional balloons and enables full stent expansion. Other balloon based vessel preparation devices were designed to modify plaque and produce more controlled, lower pressure luminal expansion without major dissections and potentially with less recoil than conventional angioplasty balloons. Scoring balloons have a helical nitinol element attached to the balloon that scores plaque facilitating uniform luminal enlargement. Further specialty balloons have been developed in recent years, including the Chocolate, Phoenix and Serranator balloons. Finally, the temporary Spur self-expanding retrievable nitinol stent has a series of radially aligned spurs that are driven into the vessel wall by post-dilatation, potentially improving drug delivery. Conclusion Lesion specific vessel preparation aims to improve both short and long term outcomes through improved penetration of anti-proliferative drug, maximising luminal gain, reducing the need for stent placement and minimising intimal injury. Some forms of vessel preparation appear to improve short term outcomes; long-term outcomes remain uncertain. An overview of some of the multiple devices available for vessel preparation is presented. |
| first_indexed | 2024-12-22T02:54:47Z |
| format | Article |
| id | doaj.art-d6c7c543874b48198261cd421220a954 |
| institution | Directory Open Access Journal |
| issn | 2520-8934 |
| language | English |
| last_indexed | 2024-12-22T02:54:47Z |
| publishDate | 2020-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj.art-d6c7c543874b48198261cd421220a9542022-12-21T18:41:18ZengSpringerOpenCVIR Endovascular2520-89342020-11-01311710.1186/s42155-020-00175-6An update on vessel preparation in lower limb arterial interventionWilliam Ormiston0Shelagh Dyer-Hartnett1Rukshan Fernando2Andrew Holden3Department of Interventional Radiology, Auckland City HospitalDepartment of Interventional Radiology, Auckland City HospitalDepartment of Interventional Radiology, Auckland City HospitalDepartment of Interventional Radiology, Auckland City HospitalAbstract Background Plain balloon angioplasty has traditionally been used to treat lower limb arterial disease but can be limited by significant residual stenosis, vessel recoil, dissection, and by late restenosis. Appropriate vessel preparation may significantly improve short and long-term outcomes. We aim to give an overview of some of the devices currently available, or under investigation, for vessel preparation in the lower limb. Main text Vessel preparation devices include those that remove plaque (atherectomy devices) and those that modify plaque. The four groups of plaque removing atherectomy devices are defined by their plaque removal method: Directional, rotational orbital and excimer laser are categories of devices investigated for plaque modification. Intravascular lithotripsy devices generate sonic pulsatile pressure waves that pass into the vessel wall cracking calcified plaques whilst sparing soft tissue. This enables dilatation of calcified lesions at low pressure by conventional balloons and enables full stent expansion. Other balloon based vessel preparation devices were designed to modify plaque and produce more controlled, lower pressure luminal expansion without major dissections and potentially with less recoil than conventional angioplasty balloons. Scoring balloons have a helical nitinol element attached to the balloon that scores plaque facilitating uniform luminal enlargement. Further specialty balloons have been developed in recent years, including the Chocolate, Phoenix and Serranator balloons. Finally, the temporary Spur self-expanding retrievable nitinol stent has a series of radially aligned spurs that are driven into the vessel wall by post-dilatation, potentially improving drug delivery. Conclusion Lesion specific vessel preparation aims to improve both short and long term outcomes through improved penetration of anti-proliferative drug, maximising luminal gain, reducing the need for stent placement and minimising intimal injury. Some forms of vessel preparation appear to improve short term outcomes; long-term outcomes remain uncertain. An overview of some of the multiple devices available for vessel preparation is presented.https://doi.org/10.1186/s42155-020-00175-6Vessel preparationPeripheral arterial diseaseIntravascular lithotripsyAtherectomyCutting balloonScoring balloon, specialty balloon, chocolate balloon, Serranator balloon, spur stent, drug-coated balloon |
| spellingShingle | William Ormiston Shelagh Dyer-Hartnett Rukshan Fernando Andrew Holden An update on vessel preparation in lower limb arterial intervention CVIR Endovascular Vessel preparation Peripheral arterial disease Intravascular lithotripsy Atherectomy Cutting balloon Scoring balloon, specialty balloon, chocolate balloon, Serranator balloon, spur stent, drug-coated balloon |
| title | An update on vessel preparation in lower limb arterial intervention |
| title_full | An update on vessel preparation in lower limb arterial intervention |
| title_fullStr | An update on vessel preparation in lower limb arterial intervention |
| title_full_unstemmed | An update on vessel preparation in lower limb arterial intervention |
| title_short | An update on vessel preparation in lower limb arterial intervention |
| title_sort | update on vessel preparation in lower limb arterial intervention |
| topic | Vessel preparation Peripheral arterial disease Intravascular lithotripsy Atherectomy Cutting balloon Scoring balloon, specialty balloon, chocolate balloon, Serranator balloon, spur stent, drug-coated balloon |
| url | https://doi.org/10.1186/s42155-020-00175-6 |
| work_keys_str_mv | AT williamormiston anupdateonvesselpreparationinlowerlimbarterialintervention AT shelaghdyerhartnett anupdateonvesselpreparationinlowerlimbarterialintervention AT rukshanfernando anupdateonvesselpreparationinlowerlimbarterialintervention AT andrewholden anupdateonvesselpreparationinlowerlimbarterialintervention AT williamormiston updateonvesselpreparationinlowerlimbarterialintervention AT shelaghdyerhartnett updateonvesselpreparationinlowerlimbarterialintervention AT rukshanfernando updateonvesselpreparationinlowerlimbarterialintervention AT andrewholden updateonvesselpreparationinlowerlimbarterialintervention |