Recoil, dissection, and restenosis in Below-The-Knee (BTK) arteries following standard balloon angioplasty

Peripheral artery disease (PAD) is a growing health problem, with symptoms ranging from intermittent claudication to chronic limb-threatening ischemia (CLTI). Balloon angioplasty in below-the-knee (BTK) PAD lesions is the mainstay treatment procedure but still a challenging one, given the heterogeneity in the patient population, multivessel and multilevel involvement, small-vessel size, long lesions (up to 40 cm), calcium burden, and lower flow rates with or without impaired runoff. The technical success of balloon angioplasty is often subverted by flow-limiting dissections, recoil with early restenosis. This review will explore current guidelines, revascularization anatomical planning, interventional approaches, and possible solutions to avoid the feared dissection, recoil and restenosis that our patients currently face.