The use of scoring balloons in the superficial femoral artery

Percutaneous transluminal angioplasty and stenting is becoming increasingly the first-line treatment for patients with both claudication and critical limb ischemia instead of surgery, with the aim of returning the patient's quality of life in the former and preventing amputation. Drug-eluting technologies have seen a large surge in popularity in recent years, and significant patient benefits have been seen with the use of drug-eluting stents and balloons over the use of plain balloon angioplasty. Unfortunately, in many patients with arterial disease there is significant vessel wall calcification - this can theoretically be a barrier to drug delivery and can also be a contributing factor to flow limiting dissection and the subsequent need for bail out stenting. Several studies have looked at the efficacy of scoring balloons to minimize these problems in patients with severe calcification. With increasing use of vascular stents over the last 5-10 years, more cases of in stent stenosis are being seen, and scoring balloons have been postulated to improve outcomes here also. Scoring balloons have been available for many years, having seen first use in the coronary system, but are now being studied in the peripheral arterial landscape, both above and below the popliteal segment. This article will review their use in the superficial femoral artery.