This preclinical study supports the feasibility of RFS implantation in peripheral arteries and demonstrates that the device undergoes early structural evolution after deployment. Virtual physiological assessment showed that these anatomical changes were accompanied by measurable reductions in flow indices, though most values remained above the 0.80 reference threshold. Together, these findings provide a basis for further development of the technology and for future studies incorporating both anatomical and virtual physiological assessment.

RFS implantation instated a largely homogeneous ESS profile that evolved with 3-month remodelling, consistent with a dynamic flow-healing interplay that warrants longer-term evaluation through full bioresorption.

Critical limb ischemia is the most advanced stage of peripheral artery disease - when blood flow to a leg or foot is so reduced that tissue is at risk of being lost. At MVM, our limb-preservation focus means many patients told they need amputation are candidates for revascularization instead.

This study suggests a potential clinical advantage of atherectomy for first-time revascularization in patients with critical limb ischemia and isolated tibial disease. The reductions in adverse outcomes suggest atherectomy offers long-term clinical benefits over angioplasty alone, warranting further investigation.

Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed.

In a real-world population with complex FPA disease, second-generation LD-DCB demonstrated 3-year clinical outcomes comparable to those of first-generation HD-DCB. These findings support the use of second-generation LD-DCB as a reasonable treatment option and suggest that comparable efficacy may be achieved despite substantially lower paclitaxel exposure.

The IN.PACT AV Access randomized trial evaluated the long-term efficacy of drug-coated balloon angioplasty in arteriovenous fistulas for hemodialysis access. The trial presented comprehensive 3-year clinical outcomes stratified by anatomic location and demographic subsets, alongside extended 5-year mortality analysis. Key findings demonstrated sustained benefits of drug-coated balloon technology in reducing restenosis rates and improving patency across diverse patient populations and fistula types. The results revealed meaningful differences in outcomes based on anatomic variations and demographic characteristics, providing clinicians with critical subgroup-specific data for treatment decision-making. The extended 5-year mortality follow-up contributed valuable information on long-term safety and survival outcomes. These results are significant for interventional nephrologists and vascular surgeons, as they establish evidence-based benchmarks for managing arteriovenous fistula complications and support the clinical adoption of drug-coated balloon angioplasty as an effective intervention strategy for maintaining hemodialysis access patency across heterogeneous patient populations.

Critical limb ischemia (CLI), also known as chronic limb-threatening ischemia (CLTI), represents the most severe stage of peripheral artery disease, characterized by severely reduced blood flow to the legs or feet that threatens tissue viability. Patients typically experience constant rest pain, non-healing wounds, and potential gangrene. MVM has established a limb-preservation focused practice that treats CLI as a vascular emergency, utilizing modern endovascular techniques to revascularize even small arteries below the knee and in the foot itself, often preserving limbs that might otherwise require amputation. The facility prioritizes rapid diagnosis and intervention, offering same-day evaluations for limb-threatening symptoms and closed-loop reporting within 48 hours. Timing is critical—early restoration of blood flow significantly improves outcomes for wound healing and limb salvage. MVM explicitly welcomes second-opinion referrals from patients facing planned amputations. Successful treatment combines revascularization with aggressive medical therapy, including smoking cessation and management of blood pressure and cholesterol. This comprehensive approach has fundamentally changed treatment possibilities for CLI patients.

The arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients’ morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty continues to be the gold-standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure. We report a 64-year-old man with a 2-stage brachiobasilic AVF that was complicated by failure 4 months after creation. An angiogram showed multiple juxta-anastomotic and midfistula stenotic lesions. Percutaneous transluminal angioplasty was successful in assisting maturation and subsequently cannulating the AVF for hemodialysis treatment. We failed to identify the underlying cause of stenosis because biopsy specimens from fistula tissue obtained at the time of transposition revealed no occlusive IH. This case emphasizes the need for additional research on factors contributing to AVF failure besides IH and highlights the need for more therapeutic options to reduce AVF failure rate.

Researchers from Bengbu Medical University and Tongling People's Hospital developed a risk stratification model for arteriovenous fistula (AVF) re-failure following percutaneous transluminal angioplasty (PTA) using intraoperative digital subtraction angiography (DSA) variables. The retrospective study analyzed 243 patients treated with Mustang™ balloons, employing Fine-Gray subdistribution hazard models with death and kidney transplantation as competing events. The analysis revealed that lesion length demonstrated a strong non-linear association with re-failure, with subdistribution hazard ratios varying significantly across lengths: 0.25 at 1 centimeter, 1.46 at 2 centimeters, and 4.31 at 3 centimeters. During follow-up, 42.4 percent of patients experienced re-failure. The final model achieved an optimism-corrected C-index of 0.79 at one year and 0.80 at two years, with lesion length carrying nearly all discriminative ability. Notably, traditional systemic markers including age, diabetes, and coronary artery calcium score showed no significant association. This finding is clinically significant as it provides a cost-effective, resource-appropriate alternative for risk stratification in resource-limited settings without requiring additional testing.

Peripheral arterial disease, a condition characterized by reduced blood supply to the lower legs due to arterial blockages, affects numerous individuals and can result in serious complications including pain, infection, and amputation. While initial treatment typically involves medication and lifestyle modifications such as smoking cessation and exercise programs, some patients require surgical intervention. Drug-eluting balloon angioplasty, which coats blood vessels with chemotherapy agents like paclitaxel during the procedure, has emerged as a promising alternative to traditional plain balloon angioplasty. A comprehensive review analyzing 31 randomized clinical trials involving 5,292 participants compared these two approaches for treating lower leg peripheral arterial disease in both thigh and leg arteries above and below the knee. The analysis revealed that drug-eluting balloons demonstrated superior outcomes in reducing the need for repeat treatments on the same artery, preventing restenosis, and minimizing late lumen loss. However, no significant differences were observed between the two techniques regarding amputation rates, amputation-free survival, mortality, ankle-brachial index changes, quality of life scores, or walking ability. These findings suggest that while drug-eluting balloons offer technical advantages in preventing vessel renarrowing, they do not translate into meaningful improvements in patient-centered outcomes.

Orbital atherectomy represents a significant advancement in treating severe coronary artery disease, particularly when conventional methods prove ineffective against calcified arterial blockages. This catheter-based procedure employs a specialized rotating device that precisely abrades hardened plaque deposits into microscopic particles, allowing them to pass safely through the bloodstream without obstruction. Unlike standard angioplasty, which relies on balloon pressure, orbital atherectomy effectively softens calcified plaque, preparing arteries for subsequent stent placement and ensuring optimal long-term outcomes. The technique is specifically designed for patients with severely calcified vessels where traditional approaches fail to adequately address blockages. Understanding arterial disease progression is crucial for patient care, as plaque accumulates gradually from cholesterol and fats before calcifying into bone-like structures resistant to conventional treatment. Early detection of peripheral artery disease through symptoms like leg discomfort during activity, cold extremities, and slow-healing wounds enables timely intervention. For patients with advanced calcification, orbital atherectomy offers a superior treatment pathway compared to standard angioplasty, combining precision with effectiveness to restore proper blood flow and maintain cardiovascular health.

This case report documents the successful application of bioresorbable scaffold technology in treating a patient with chronic limb ischemia, a condition characterized by severely reduced blood flow to the extremities. The clinical team implanted a bioresorbable scaffold—a temporary support structure designed to gradually dissolve as the body heals—to restore vascular function and improve tissue perfusion. Bioresorbable scaffolds represent an advancement over traditional permanent stents, as they provide initial mechanical support while eventually being absorbed by the body, theoretically reducing long-term complications such as chronic inflammation and restenosis. This case demonstrates the potential of bioresorbable scaffold technology to address the challenging clinical problem of chronic limb ischemia, where treatment options are often limited. The successful outcome underscores the importance of exploring innovative interventional approaches for peripheral vascular disease, offering hope for patients with this serious condition who face risks of amputation and disability without effective revascularization.

# Professional Summary Researchers conducted the SUCCESS PTA real-world single-arm study to evaluate sirolimus-eluting balloons as a treatment for peripheral artery disease. This open-access study, published in August 2026 in CVIR Endovascular, investigated the efficacy and safety of this innovative drug-coated balloon technology in clinical practice beyond controlled trial settings. Sirolimus-eluting balloons represent an advancement in interventional cardiology, combining mechanical angioplasty with controlled drug delivery to reduce restenosis rates. The real-world nature of the SUCCESS PTA study provided valuable data on how the technology performs across diverse patient populations and clinical scenarios, rather than in strictly controlled environments. The findings from this trial contribute important evidence regarding the sirolimus-eluting balloon's effectiveness in preventing vessel re-narrowing and improving long-term outcomes for peripheral artery disease patients. This research matters significantly to interventional cardiologists and vascular specialists seeking evidence-based alternatives to traditional balloon angioplasty and stenting approaches, potentially improving treatment options and patient outcomes in peripheral vascular interventions.

Surface vibration analysis using HAVSE demonstrated physiologically coherent patterns in isolated perianastomotic and outflow stenoses but limited discriminatory performance in multifocal or central venous disease, supporting further device development and validation in larger studies that incorporate Doppler ultrasound correlations and standardized acquisition protocols.

Compared with PTA, DCBs and DES demonstrated higher primary patency and lower binary restenosis, and DCBs reduced late lumen loss, percentage in-lesion diameter stenosis, and clinically driven target lesion revascularization.

Arteriovenous fistulas (AVF) dysfunction due to recurrent stenosis can compromise effective renal replacement therapy in patients with end-stage kidney disease (ESKD). Timely salvage of failing AVFs is therefore essential. This retrospective study aims to evaluate the 1-year outcomes of interwoven nitinol stent placement for treatment of dysfunctional forearm arteriovenous fistulas (AVFs) due to juxta-anastomotic (JAS) stenosis in patients with end-stage kidney disease.

Kidney function may modify the comparative effectiveness in limb ischemia. Surgery is associated with fewer limb reinterventions regardless of kidney function. In advanced kidney disease, higher death risk offsets surgery’s limb benefit. Treatment decisions should account for competing risk of death.

The available evidence on atherectomy in peripheral artery disease remains heterogeneous and, in part, conflicting. Randomized controlled trials across different device platforms and anatomical segments have consistently confirmed its ability for lumen gain without barotrauma, resulting in lower dissection rates and lower rates of bail-out stenting, but also failed to demonstrate its superiority over balloon angioplasty, drug-coated balloons, or contemporary stent-based strategies with respect to long-term patency, freedom from reintervention, or limb-related outcomes. Procedure-specific risks, including distal embolization and health-economic considerations, do not support the routine use of atherectomy but rather its anatomy-driven use in selected segments and lesion morphologies and patients with adequate distal run-off (Fig. 4). Its responsible use requires careful integration of available evidence, operator expertise, and consideration of alternative technologies. Future research focusing on morphology-guided patient selection and imaging-supported strategies is essential to better define its optimal role in contemporary endovascular practice.

Arteriovenous (AV) fistulas, the preferred vascular access for hemodialysis, fail to mature in up to 60% of patients with kidney failure. This high failure rate is often attributed to adverse hemodynamic conditions, yet the exact mechanisms remain poorly understood. This review explores the application of computational fluid dynamics and machine learning to elucidate these mechanisms and predict clinical outcomes. Computational fluid dynamic models have been instrumental in characterizing the complex interplay between AV fistula geometry, such as anastomotic angle and curvature, and hemodynamic parameters, such as wall shear stress and oscillatory shear index. These studies consistently link disturbed flow patterns, including low wall shear stress and high oscillatory shear index, to regions prone to neointimal hyperplasia and stenosis. Concurrently, machine learning models have demonstrated significant promise in predicting AV fistula maturation, stenosis, and failure by leveraging diverse data sources, including clinical characteristics, ultrasound imaging, and acoustic bruit analysis.