Utilization of debulking strategies in endovascular interventions in peripheral arterial disease

The goal of debulking strategies in endovascular interventions for peripheral arterial disease is to achieve a more uniform angioplasty result through plaque removal or plaque modification. This minimizes vessel wall barotrauma and maximizes acute luminal gain at lower inflation pressures. Improvement in drug delivery and reduced risk of restenosis with the use of a debulking strategy prior to the drug coated balloon (DCB) is hypothesized as an added benefit. However, the long-term benefits of atherectomy remain unclear with some studies suggesting worse outcomes with atherectomy. There are a plethora of debulking devices available to treat calcified peripheral arterial disease which will be reviewed in this book chapter.