The evidence to support the use of focal force balloon technology to improve outcomes in the treatment of lower extremity arterial occlusive disease

Despite recent advances in endovascular therapy of lower extremity atherosclerotic disease, mainly driven through drug eluting balloon angioplasty, treatment of complex lesions remains challenging. Drug-eluting balloons work less well in heavily calcified lesions and in particular long lesions often require bail-out stenting. Lesion preparation, as a stand-alone treatment or before delivering antiproliferative therapy or scaffolding, has gained increased recognition in recent years. Focal force or other specialty balloons are designed to prepare complex lesions to improve acute technical success and, ideally, long term patency of the vessel. There are numerous dedicated balloons on the market that use different modes of action to prepare the lesions. The current review focuses on mechanistic insights and the evidence behind those specialty balloons.