In two additional interviews, Dr. Dua and Dr. Li offered their expertise regarding Advance Serenity from individual procedural perspectives.
Dr. Dua on navigating tough lesions
How does Serenity fit into your PAD algorithm?
I use Serenity balloons for below-the-knee pathology where trackability is essential to reach those tough lesions.
What type of lesions is Serenity best suited for?
Any lesion that is exceptionally tight or calcified is appropriate for this balloon, as I have almost always been able to track a Serenity balloon to the location I need to because of the way the tip travels.1
How do you feel about having a large matrix (5-10mm x 20-150mm) of Serenity for SFA (superficial femoral artery) work?
We have a nice repertoire of balloons that work in the SFA, so I think the special sauce of Serenity is really in the work it does for below-the-knee procedures.
How does the laser-formed tip aid in trackability?
I think this is the ticket to why the balloon glides so well and can reach very difficult locations that are tough to traverse with conventional balloons.1
Dr. Li on treatment trends
What are the particular PAD disease states that Serenity best treats?
I have been using the Serenity balloon for our patients with tibial disease. In many patients with diabetes and ESRD, you may not see the typical femoropopliteal distribution of occlusive PAD that had traditionally been treated with bypass surgery. Often in these patients, you lose your outflow vessels first, which speaks to the importance of avoiding injury to the tibial arteries as there often is no open surgical option if endovascular techniques fail. Serenity, in my experience, has been particularly helpful in this arterial bed.
What are the trends you’ve seen in treating PAD?
In addition to new devices that serve as an adjunct to plain angioplasty (lithotripsy, tacks, etc.), I have been noticing that there is a drive to treat areas that we did not consider fruitful in the past. For some physicians, even intervention on tibial disease is not common practice, and we are now seeing an increased interest in treating pedal disease. This would open up a new horizon in the area of limb salvage since we are often limited in options once we have crossed the ankle joint.
How do you feel about having a large matrix (5-10mm x 20-150mm) of Serenity for SFA work?
SFA is a territory that has multiple modalities of treatment ranging from plain angioplasty to open bypass. It can be difficult to introduce such a simplistic product to an area that has been heavily studied and tread upon, but the simplicity in itself will likely be its main highlight. I have already been using the smaller balloons as a way to traverse and predilate challenging tight lesions in larger arteries, and I imagine that a larger balloon would be helpful in this aspect as well. This, of course, would not be limited to SFA as this could also pertain suitably to iliac arteries particularly in the larger sizes.
How does the laser-formed tip help create a smooth transition to cross complex lesions?
This is a question I have a hard time answering since I have not considered the mechanisms of the balloon because it rarely fails. It is not just a matter of ability to cross, but also minimizing trauma to the lumen when crossing, particularly in tibial arteries where there are few technical solutions to dissection or perforation. Although these may not be devastating complications, when the only vessel you can improve upon is affected, this undoubtedly can lead to a worse outcome for the patient.
