Collateral vessel size and number could predict severe dissection after balloon angioplasty in patients with femoropopliteal artery chronic total occlusion

Collateral vessels develop from pre-existing arterioles in response to shear stress from arterial stenosis and mechanosensor activation. Animal studies suggest that these vessels increase in number and size after arterial occlusion, potentially offering a natural bypass and protection against critical limb ischemia. Efforts to enhance collateral vessel growth aim to improve walking performance in peripheral arterial disease (PAD). Factors influencing collateral vessel formation include plaque accumulation, tissue components, and comorbid conditions. Balloon angioplasty is a primary treatment for PAD but often leads to vessel dissection, with severe dissections linked to reduced long-term patency and requiring additional treatments. The relationship between collateral vessel characteristics and dissection severity remains unexplored.