PAD: Atherectomy

Overview

Peripheral Artery Disease Intervention Treatments: Jaikirshan Khatri, MD

What is atherectomy for PAD?

Peripheral artery disease (PAD) happens when plaque builds up in your arteries, causing them to become narrow and block your blood flow. This plaque build-up is atherosclerosis. In an atherectomy, healthcare providers remove plaque with a catheter with a sharp blade or laser on its end. The sharp blade or laser lets them cut out or scrape out the hard plaque. Your provider may also perform angioplasty (ballooning) or stent placement.

How common are atherectomies?

In the U.S., about 6.5 million people ages 40 and older have PAD. Researchers estimate that healthcare providers in the U.S. perform more than 190,000 atherectomies annually.

What are the types of atherectomies?

All atherectomies remove plaque buildup from your arteries. Healthcare providers may use different types of blades or use lasers to remove plaque:

  • Excisional atherectomy: A blade cuts plaque in one direction.
  • Laser ablation atherectomy: A laser destroys plaque.
  • Orbital atherectomy: A spinning tool works like sandpaper to remove plaque.
  • Rotational atherectomy: Tiny blades cut plaque in a circular motion.

Procedure Details

What happens before atherectomy?

Your healthcare provider may recommend certain tests to see narrowing or blockages in your arteries. You may have:

Follow your provider’s instructions to prepare for the procedure, including whether you should:

Your provider tells you when to arrive on the day of the procedure. When you arrive, you change into a hospital gown. A provider inserts a catheter to deliver anesthesia so you won’t feel pain during atherectomy.

What are the details of an atherectomy procedure?

After you receive local anesthesia and mild sedation, your healthcare provider:

  • Inserts the catheter into your artery.
  • Moves the catheter along your artery to access the narrow or blocked area.
  • Uses the blade or laser at the end of the catheter to scrape or cut the plaque so they can remove it.

Your healthcare provider may repeat the process several times until they remove enough plaque so blood can flow through your artery.

What happens after atherectomy?

You need to lie flat for up to six hours after atherectomy to prevent bleeding. Healthcare providers will monitor your blood pressure, pulse and heart rate while you recover.

Risks / Benefits

What are the advantages of atherectomy?

Atherectomy often relieves PAD symptoms without major surgery. Atherectomy is a minimally invasive procedure. Healthcare providers make just one small puncture to get to your artery. It typically takes about two hours to perform the procedure.

Are there risks or complications of atherectomy?

Sometimes a piece of plaque can break off and become lodged or stuck in a smaller downstream blood vessel as healthcare providers cut or scrape away plaque. The atherectomy procedure can also cut too deep and create a tear or hole in your blood vessel.

Recovery and Outlook

How long does it take to recover from atherectomy?

Most of the time, atherectomy is an outpatient procedure, meaning you can go home the same day. You may spend one day in the hospital. Your healthcare provider lets you know what to expect based on your situation. Most people are able to resume their typical activities a few days after their procedure. Everyone’s situation is different, so ask your healthcare provider when you can go back to your routine.

When to Call the Doctor

When should I call my healthcare provider after atherectomy?

Tell your healthcare provider if you have any new or worsening symptoms, especially:

  • Painful areas in your groin or leg.
  • Swelling (edema).
  • Redness or warmth.
  • Coldness or numbness in the treated leg.

A note from Cleveland Clinic

An atherectomy is a minimally invasive way to remove plaque from blood vessels, opening up your arteries so your blood can flow normally. Healthcare providers often use this procedure to treat peripheral artery disease (PAD). If you have this condition, an atherectomy may be one way to ease your symptoms.

Last reviewed by a Cleveland Clinic medical professional on 10/19/2022.

References

  • Centers for Disease Control and Prevention. Peripheral Artery Disease (PAD). (https://www.cdc.gov/heartdisease/PAD.htm) Accessed 10/19/2022.
  • Charitakis, K, Feldman, D. Atherectomy for Lower Extremity Intervention: Why, When, and Which Device? (https://www.acc.org/latest-in-cardiology/articles/2015/06/16/07/58/atherectomy-for-lower-extremity-intervention) American College of Cardiology. 2015 June 16. Accessed 10/19/2022.
  • iData Research. Over 190,000 Atherectomy Procedures Performed Every Year in the United States. (https://idataresearch.com/over-190000-atherectomy-procedures-performed-in-the-united-states/) Accessed 10/19/2022.
  • RadiologyInfo.org. Peripheral Artery Disease (PAD). (https://www.radiologyinfo.org/en/info/pad) Accessed 10/19/2022.
  • Topfer LA, Spry C. New Technologies for the Treatment of Peripheral Artery Disease. (https://www.ncbi.nlm.nih.gov/books/NBK519606/table/peripheral-artery-disease.t1/) 2018 Apr 1. In: CADTH Issues in Emerging Health Technologies. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016-. Table 1, [Types of Atherectomy Devices]. Accessed 10/19/2022.
  • Wardle BG, Ambler GK, Radwan RW, Hinchliffe RJ, Twine CP. Atherectomy for peripheral arterial disease. (https://pubmed.ncbi.nlm.nih.gov/32990327/) Cochrane Database Syst Rev. 2020 Sep 29;9(9):CD006680. Accessed 10/19/2022.

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