New therapeutic options for lower extremity arterial calcification in the era of endovascular treatment

Lower extremity arterial calcification is a significant health concern. Despite conventional endovascular interventions such as balloon angioplasty and stenting, many patients fail to reconstruct blood flow in the target vessel due to the hard, calcified plaque. The ongoing advancement of endovascular techniques has thus generated new therapeutic alternatives. Atherectomy encompasses directional atherectomy (DA), rotational atherectomy (RA), orbital atherectomy (OA), and laser atherectomy (LA). DA and LA systems may be preferred for eccentric calcification with a low circumferential arc involvement, whereas RA and OA systems may often be preferred for other patterns, although current direct comparative studies are limited. However, atherectomy is ineffective against deep-seated calcification, an area where intravascular lithotripsy has made a breakthrough. In summary, various innovations in endovascular therapy offer more effective and novel treatment options for calcified lesions in lower extremity arteries.