Below the Ankle Treatment with Serranator
Nicholas Petruzzi, MD
AMI Vascular Institute
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Every year, we’re seeing more pedal interventions—plantar loop recanalizations, retrograde access, and other advanced techniques. When treating this type of disease, it’s critical to have options, and right now, those options are limited. Serranator is one of the unique tools we can use below the ankle.
Below-the-ankle patients present a special challenge, as bailout options are extremely limited. With Serranator, we’ve seen lower rates of dissection and reduced need for bailout stenting, even in below-the-knee cases. Often, I use it as a primary strategy in below-the-ankle interventions, particularly for difficult or tortuous lesions.
I’ve been really impressed by its deliverability. At first glance, you might think it’s just another peripheral cutting or scoring balloon, but it’s quite different. The small serrations create focal force points in the intima, allowing controlled expansion and precise, controlled force application.
Below the knee, I often combine Serranator with orbital atherectomy. The Serranator balloon allows low-pressure inflation while delivering high-force energy to the vessel. This achieves expansion at low pressures, which leads to fewer dissections and reduces the need for stenting.
This is another tool in your armamentarium. Options are limited for advanced below-the-knee and below-the-ankle disease, but adding Serranator to my practice has produced impressive results.
