Lower Extremity Arterial Atherectomy

Lower Extremity Arterial Atherectomy is a minimally invasive endovascular procedure used to remove atherosclerotic plaque from the walls of arteries in the legs. It's primarily used to treat Peripheral Arterial Disease (PAD) when plaque buildup narrows or blocks blood flow to the lower limbs.

Unlike angioplasty, which compresses plaque against the arterial wall, atherectomy cuts, shaves, or vaporizes the plaque, helping restore better blood flow with less trauma to the artery.

🔹 Indications for Atherectomy

Atherectomy is often considered when:

• The plaque is calcified or eccentric (irregularly shaped).
• Angioplasty or stenting alone is not effective or poses a higher risk.
• In-stent restenosis (narrowing inside a previously placed stent).
• The goal is to avoid stenting, especially in areas like the popliteal artery (behind the knee) where stents are prone to complications due to bending and flexion.
• Disease process involves a significant length of the artery.
• Chronic total occlusions.

🔸 Types of Atherectomy Devices

There are several atherectomy techniques, each using different mechanisms:

1. Directional Atherectomy
• Uses a cutting blade to shave plaque.
• Example: SilverHawk, TurboHawk.
2. Rotational Atherectomy
• Uses a spinning burr or blade to grind plaque into tiny particles.
• Example: Rotablator, Jetstream.
3. Orbital Atherectomy
• Uses an eccentrically mounted spinning crown to sand the plaque.
• Example: Diamondback 360°.
4. Laser Atherectomy
• Uses laser energy to vaporize plaque.
• Example: Turbo-Elite laser catheter.

Each method is chosen based on lesion characteristics, vessel location, and physician preference.

🔹 Procedure Overview

1. Access: Typically through a puncture in the femoral artery in the groin.
2. Imaging: An angiogram is performed to locate and assess the blockage.
3. Plaque Removal: The atherectomy device is advanced to the lesion and activated to remove the plaque.
4. Adjunct Therapy: Balloon angioplasty and/or stenting may follow, if needed.
5. Closure & Recovery: The access site is closed, and the patient is monitored post-procedure.

🔸 Benefits of Atherectomy

• Plaque debulking allows for better vessel expansion. This helps with better drug delivery when using drug-coated balloons. Facilitates better stent expansion when needed.
• May reduce the need for stents.
• Useful in calcified lesions or long-segment disease.
• May reduce balloon barotrauma and risk of dissection and perforation.

🔸 Risks & Complications

While generally safe, possible complications include:

• Embolization: Plaque particles may travel downstream and block smaller arteries (often mitigated with embolic protection filters).
• Vessel dissection or perforation
• Bleeding or hematoma at the access site
• Restenosis over time
• Infection, although rare

🔹 Post-Procedure Care

• Antiplatelet therapy is typically prescribed (e.g., aspirin, clopidogrel).
• Regular follow-up with duplex ultrasound to monitor artery patency.
• Lifestyle changes:
• Smoking cessation
• Regular walking/exercise
• Control of blood pressure, cholesterol, and diabetes