PAD: Atherectomy

Overview

Atherectomy aims to restore normal blood flow and relieve symptoms of peripheral artery disease (PAD), which occurs due to atherosclerosis or the accumulation of plaque in the arteries, resulting in their narrowing and blockage. This minimally invasive procedure removes plaque buildup and unblocks arteries that have become narrow or obstructed.

An atherectomy involves the use of a catheter equipped with either a sharp blade or a laser to either cut out or scrape away the hardened plaque. In certain cases, angioplasty using a balloon or stent placement to address the condition may be performed.

Types

There are several methods for atherectomies, such as:

• Orbital atherectomy: Plaque is removed using a spinning tool that functions like sandpaper.
• Rotational atherectomy: Small blades spin to cut the plaque.
• Excisional atherectomy: Plaque is cut in one direction using a blade.
• Laser ablation atherectomy: Plaque is eliminated by a laser.

Risk

Although, atherectomy is a minimally invasive procedure, it still carries risks, such as:

• Cutting too deeply, leading to a tear or hole in the blood vessel
• A fragment of plaque may dislodge and get stuck in a smaller downstream blood vessel as healthcare providers remove or scrape away plaque

Before the procedure

Prior to the procedure, the instructions provided may encompass dietary restrictions, medication considerations, particularly regarding anticoagulants, and other relevant preparations. Specific tests to assess potential narrowing or blockages in the arteries, such as angiography or vascular ultrasound may also be required.

During the procedure

PAD atherectomy typically lasts for around two hours. Upon arrival, patients will be required to change into a hospital gown. A catheter is inserted to administer anesthesia to ensure that one will not experience pain during the atherectomy.

Following the local anesthesia and mild sedation, the healthcare provider initiates the procedure by inserting a catheter into the artery. The catheter is carefully maneuvered along the artery to reach the targeted narrow or blocked region. A blade or laser located at the catheter’s end is utilized to scrape or cut the plaque, facilitating its removal.

The atherectomy procedure may be repeated multiple times until sufficient amount of plaque is removed and allowing for the restoration of normal blood flow through the artery.

After the procedure

Throughout the recovery period, healthcare providers will closely monitor blood pressure, pulse, and heart rate to ensure a safe and controlled recuperation process. To prevent bleeding, it is necessary that one remains in a flat position for up to six hours following the atherectomy.

Outcome

In some cases, a hospital stay of one day may be required, depending on individual circumstances. However, most cases of atherectomy are performed as an outpatient procedure, allowing patients to return home on the same day.

It is important to carefully monitor one’s recovery after the procedure. Seek immediate medical attention if any of the following signs and symptoms occur:

• Edema
• Warmth or redness
• Numbness or coldness in the leg that has been treated
• Pain in the leg or groin area

Atherectomy frequently alleviates symptoms of PAD without the need for extensive surgery. Resumption of regular activities typically occurs within a few days post-procedure or upon the healthcare provider’s advice.