Controlling Dissections in Peripheral Arterial Interventions

Dissections are universal during the endovascular treatment of lower extremity peripheral arterial disease. High-grade dissections and high residual narrowing predict higher target lesion revascularization and reduced patency rates. Using intravascular ultrasound, the depth and width of dissections can be more accurately classified. Several devices are now available to reduce deeper dissections with a wide range of plaque removal from none to soft debulking (>50% residual) to aggressive debulking (<50% residual). The interaction between the degree of debulking, deep dissections, application of antiproliferative therapies, and dissection repair is discussed in this chapter. Further data are needed to determine the impact of dissections on long-term outcomes.