Advancements in endovascular techniques and treatments have helped many patients avoid traditional, open surgery for peripheral artery disease (PAD). Conventional balloon angioplasty has been widely used for focal lesions and has a high success rate. Yet, elastic recoil, dissection and poor primary and secondary patency rates for long lesions have necessitated other procedural methods for areas of severe calcification. Thus, as a way to “debulk” plaque from diseased arteries, an atherectomy is performed. In the majority of cases, atherectomy is combined with a low-pressure balloon angioplasty procedure without actually placing a stent. However, in other cases, an atherectomy is used to prep the blood vessel before stenting to prevent restenosis or re-narrowing of the vessel.
When it comes to femoropopliteal, or small vessel infrapopliteal disease, four methods of atherectomy may be used: plaque excision (directional) atherectomy, rotational atherectomy/aspiration, laser atherectomy and orbital atherectomy. Depending on the device used, calcified plaque can be cut, shaved, sanded or vaporized.
With peripheral artery disease (PAD) on the rise, management and treatment modalities for lower extremity PAD has also expanded, moving beyond the stent-first approach. While angioplasty remains an effective treatment, there are a greater number of stent fractures and restenosis reported as a result of specific movements (compression, torsion, bending) in relation to the femoral and other lower-extremity arteries. Thus, an atherectomy is appealing for several reasons.
In lesions that are greater than 10 cm., or in those with heavy calcification, the effectiveness of stents is limited. The same is true in constrained areas and joint spaces, which are believed to be one reason for stent failure. While some atherectomy procedures have the ability to provide revascularization without the need for additional treatment (directional atherectomy), other positive aspects of atherectomy is that it is non-invasive, and calcified plaque can be removed without damaging the vessel wall. This also reduces the chance of acute complications.
Without question, atherectomy devices and methodology continue to evolve. While atherectomy is a promising treatment method for PAD, specifically of the lower extremity vessels, appropriate usage and device selection are key.
Dr. Alan I. Benvenisty, MD, a prominent vascular and endovascular surgeon in New York City, delivers personalized patient care that is tailored to specific vascular conditions. With careful consideration of the patient’s present and past health history, family health history and lifestyle, as well as extensive knowledge regarding the anatomy of lower extremity vessels, patients feel at ease with Dr. Benvenisty’s conscientious approach to treatment. To meet with Dr. Benvenisty, contact our office on Amsterdam Avenue to schedule an appointment.