Peripheral artery disease (PAD) is a common condition where the arteries in the arms and legs become narrowed. This narrowing is due to a buildup of fatty deposits (plaques) inside the artery walls, a process known as atherosclerosis. As a result, blood flow is reduced, which can cause pain when you walk (claudication) or engage in physical activities. In severe cases, PAD can lead to serious complications, including the risk of losing a limb if left untreated.
What is an atherectomy?
Atherectomy is a procedure that physically removes plaque buildup from arteries. It uses specialized devices to cut, shave, or vaporize the plaque, clearing the blockage.
Traditional treatments for atherosclerotic artery disease include lifestyle modifications, medications, and procedures such as endarterectomy (surgical plaque removal) and angioplasty (balloon artery widening). While angioplasty effectively widens narrowed arteries, it may be limited in cases of heavily calcified plaques. Endarterectomy, while effective, is a more invasive surgical procedure requiring a larger incision. Atherectomy offers a more targeted approach, directly removing arterial plaque and improving blood flow.
Atherectomy can be used to treat blockages in various arteries, including peripheral arteries in the legs (for PAD), coronary arteries (for heart disease), and carotid arteries (to prevent stroke).
How does it work?
The atherectomy procedure typically involves these steps:
Initial preparation
The patient is positioned comfortably, and the area where the catheter will be inserted (usually the groin) is cleaned and numbed.
Catheter Insertion
A small incision is made, and a catheter is inserted into the artery.
Guidance to the blockage
Using X-ray imaging (fluoroscopy), the vascular specialist guides the catheter to the blocked artery.
Plaque removal
The atherectomy device is activated to remove the plaque. The type of device used depends on the nature and location of the plaque. Some devices cut the plaque into small pieces, while others shave it away.
Removal of debris
The removed plaque is collected within the chamber and removed from the body. Also, there are distal protection filters that prevent the plaque from escaping.
Final assessment
After the plaque is removed, the vascular surgeon assesses the artery to ensure adequate blood flow. The catheter is removed, and the incision is closed.
Recovery and follow-up
Following the procedure, patients typically need to lie flat for several hours to prevent bleeding at the incision site. Most patients go home the same day. Many can resume light activities within 24-48 hours.
Potential risks and complications
Like any medical procedure, atherectomy carries some risks. Complications can include bleeding, vessel damage, or re-narrowing of the artery over time.
Several atherectomy techniques may be used depending on the type of blockage:
Directional Atherectomy
Directional atherectomy is the procedure used. It uses a rotating cutting blade to shave plaque from vessel walls, collecting material for removal. Ideal for eccentric plaque deposits.
Directional atherectomy is a specialized procedure that employs a rotating cutting blade to shave plaque from artery walls, effectively collecting and removing the debris. This technique is ideal for eccentric plaque deposits, offering a targeted approach to clearing clogged arteries.
Who is a candidate for an atherectomy?
Atherectomy is particularly beneficial for patients with:
- Calcified or hardened plaque deposits are resistant to balloon angioplasty
- Long segment blockages in peripheral arteries
- Blockages at vessel branching points (bifurcations)
- Restenosis (re-narrowing) of previously treated arteries
- Chronic total occlusions (completely blocked arteries)
- Diffuse disease affecting significant portions of the vessel
Ideal candidates typically experience symptoms of arterial blockage, such as:
- Leg pain during walking (claudication)
- Pain at rest, especially when lying down (critical limb ischemia)
- Non-healing wounds on the extremities
- Skin changes on affected limbs, including shiny, thin skin or discoloration
- Limited mobility due to circulation problems
The procedure may not be suitable for everyone. Patients with certain bleeding disorders, kidney dysfunction, or those who cannot take blood-thinning medications may require alternative treatments. Additionally, severely tortuous (twisted) vessels may present challenges for atherectomy devices.
Benefits of atherectomy for treating artery blockages
Atherectomy offers several advantages over other treatments for arterial blockages:
Atherectomy is an effective treatment for many patients, with a high success rate and fewer complications than more invasive surgical procedures.
When to consult a doctor
If you experience symptoms that might indicate arterial blockages, it’s important to seek medical attention. These warning signs include:
The risk factors for arterial disease include:
As the number one provider of atherectomy in Southern California, Empire Vein & Vascular Specialists offers personalized care with the latest technology. Our team of board-certified vascular specialists is dedicated to supporting patients with PAD. We offer a wide range of vascular services in Southern California, and expert vascular specialists are readily available to provide the care you need. We accept most insurances, including Medicare, most PPOs and HMOs, and IEHP.
We pride ourselves on delivering exceptional patient experiences, as reflected in the feedback from our satisfied patients. Gene noted, “Thorough explanation of results of recent tests. Not rushed. Asked several times if I understood. I was most impressed by the professionalism.” This commitment to clear communication and patient understanding is at the heart of our practice.
Call us now at 1.800.VARICOSE (1-800-827-4267) or visit our website to book an appointment.
- CDC.gov, About Peripheral Arterial Disease (PAD) (source)