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Weiss J. S. 1, Bazan H. A. 1, Nishibe T. 2, Wong J. M. 1, Dardik A. 1,3
1 Section of Vascular Surgery Department of Surgery Yale University School of Medicine, New Haven, CT, USA
2 Division of Cardiovascular Surgery Department of Surgery Fujita Health University, Toyoake, Japan
3 Department of Surgery VA Connecticut Healthcare Systems, West Haven, CT, USA
The incorporation of endovascular procedures in the routine treatment of peripheral arterial lesions has revolutionized the field of vascular surgery. Although angioplasty has supplanted surgery as the primary treatment modality in many areas of the vasculature proximal to the inguinal ligament, the significant hurdle of long-term patency has prevented infrainguinal arterial angioplasty from completely replacing surgical bypass. Since neointimal hyperplasia is the key factor implicated in the restenosis of angioplasty-treated vessels, many adjunctive methods are targeted to reduce this biological response and improve the durability of angioplasty. Cutting balloon angioplasty (CBA) utilizes microtomes attached to a standard rigid balloon to score the vessel wall and allow controlled dissection of the artery. This variation of angioplasty is thought to minimize vessel wall trauma and subsequent inflammatory responses, reducing neointimal hyperplasia and restenosis. We review the literature on CBA, both its theoretical basis as well as its current results in the infrainguinal arterial tree.