Treatment for Arterial Disease: Atherectomy

April 19, 2018
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Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine if it is superior to angioplasty.

Until recently, the go to treatment for peripheral artery disease patients suffering from leg pain due to advanced arterial blockages was balloon angioplasty or stents. However, today an additional minimally invasive procedure, atherectomy is available that successfully clears blocked arteries helping patients to return to an active lifestyle more quickly.

Atherectomy, performed under a local atheistic, utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. The procedure is performed in a hospital surgical, interventional, or catheterization suite by a trained vascular surgeon. No inpatient stay is required.

There are many benefits to choosing an atherectomy as treatment for peripheral artery disease. Atherectomies are especially recommended when angioplasty and stenting are not possible. This can occur when the blockage is in a particularly difficult to reach location, or is too hardened or severe to be flattened with the angioplasty balloon or stent device alone. Because it scrapes away these difficult to reach, hardened plaques, atherectomy is frequently used as a preliminary step prior to angioplasty or stenting.

An atherectomy is especially helpful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents. This procedure is not ideal for every PAD patient. Your doctor can evaluate and recommend treatment according to your individual health needs.

During an atherectomy procedure, after a mild sedative is given through an IV, the surgical team will administer a local atheistic to the site of procedure normally the groin area. Then a catheter is inserted into the artery through a small puncture in the artery. The catheter is then guided carefully through the artery with the help of an ultrasound to the blockage. The catheter has a collection chamber in the tip allowing the removal of plaque as the device is removed from the artery. The process can be repeated at the time the treatment is performed to remove a significant amount of disease from the artery.

Why is this atherosclerosis atherectomy procedure performed? Why do I need this procedure?

The goal of treatment is to eliminate the build-up of plaque in your arteries.

You may need this atherectomy procedure if your arteries become too narrowed or blocked from plaque inside the artery walls. If arteries are blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength.

An atherectomy is especially helpful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents.

This procedure is not ideal for everyone. Each patient is evaluated, and treatment will be individualized for the patient’s circumstances.

Atherectomy carries the same minimal risks as other minimally invasive procedures. However, it is the only technique that actually removes plaque from the vessel. Some patients report feeling pressure or pushing sensations while the procedure is conducted, but typically no pain is reported.

After the procedure, patients are asked to gradually increase mobility, initially lying flat for a few hours, then sitting up. Patients are then walking between 6 to 24 hours after the procedure with normal activity typically being resumed within 24 to 48 hours.

Atherectomy usually has no complications, but as with any surgery, there is a risk of complications, such as embolization (the dislodgement of debris that blocks the arteries in the lower part of the leg) and perforation. These complications, however, are rare. An unusual complication of atherectomy is the re-blockage of the artery (restenosis) that may occur later, especially if you smoke cigarettes. Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you.

To determine if you’re a good candidate for atherectomy, you should consult an interventional radiologist or vascular surgeon in your area that specializes in treating PAD to discuss your diagnosis and potential treatment. PAD treatment options vary based on the specifics of your individual case, and it’s important to begin treatment as soon as possible.

If you have PAD or if you are concerned that you may have it, contact us at Coastal Vascular Center today. We have a range of treatment options and can work with you on strategies to lower your risk of peripheral artery disease.

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