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. 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. 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.

中文翻译：

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下肢动脉介入血管准备的最新进展

普通球囊血管成形术传统上用于治疗下肢动脉疾病，但会受到明显残余狭窄、血管回缩、夹层和晚期再狭窄的限制。适当的血管准备可以显着改善短期和长期结果。我们旨在概述一些目前可用或正在研究的用于下肢血管准备的设备。血管准备装置包括去除斑块的装置（斑块切除装置）和修饰斑块的装置。这四组斑块去除斑块切除装置由它们的斑块去除方法定义：定向、旋转轨道和准分子激光是研究用于斑块修饰的设备类别。血管内碎石装置产生的声波脉冲压力波进入血管壁，使钙化斑块破裂，同时保留软组织。这可以通过常规球囊在低压下扩张钙化病变，并实现支架完全扩张。其他基于球囊的血管准备装置旨在改变斑块并产生更受控、压力更低的管腔扩张，而无需进行大的解剖，并且可能比传统血管成形术球囊具有更少的反冲力。评分球囊具有连接到球囊的螺旋镍钛诺元件，该元件对斑块进行评分，有助于均匀的管腔扩大。近年来，还开发了更多的特种气球，包括巧克力、凤凰和塞拉纳托气球。最后，临时 Spur 自膨胀可回收镍钛诺支架具有一系列径向对齐的支架，这些支架通过后扩张进入血管壁，可能会改善药物输送。病变特异性血管准备旨在通过提高抗增殖药物的渗透性、最大化管腔增益、减少支架放置的需要和最小化内膜损伤来改善短期和长期结果。某些形式的血管准备似乎可以改善短期结果；长期结果仍然不确定。概述了一些可用于血管准备的多种设备。病变特异性血管准备旨在通过提高抗增殖药物的渗透性、最大化管腔增益、减少支架放置的需要和最小化内膜损伤来改善短期和长期结果。某些形式的血管准备似乎可以改善短期结果；长期结果仍然不确定。概述了一些可用于血管准备的多种设备。病变特异性血管准备旨在通过提高抗增殖药物的渗透性、最大化管腔增益、减少支架放置的需要和最小化内膜损伤来改善短期和长期结果。某些形式的血管准备似乎可以改善短期结果；长期结果仍然不确定。概述了一些可用于血管准备的多种设备。