Atherectomy
Encyclopedia
Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis
from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities. It has also been used to treat coronary artery disease, albeit ineffectively.
and stents, which push plaque into the vessel wall, atherectomy involves removing the plaque burden within the vessel. Increasing the vessel
lumen
by removing the plaque burden improves downstream wound healing, reduces claudication
and pushes amputation levels more distal. While atherectomy is usually employed to treat arteries
it can be used in vein
s and vein grafts as well.
Atherectomy falls under the general category of percutaneous
revascularization
, which implies re-canalizing blocked vasculature via a needle puncture in the skin. The most common access point is near the groin through the common femoral artery
(CFA). However, wire and catheter access can occur from wherever a doctor is willing to stick. Other common places are the brachial artery
, radial artery
, popliteal artery
, dorsalis pedis, and others.
, which involves the surgical cut down and removal of plaque from the inner wall of a diseased vessel.
The advantages of atherectomy when compared to endarterectomy include less procedure time, ease of use, faster patient recovery, decreased systemic complications, repeatability in light of new occlusions. It also serves as a chance for non-surgical candidates.
The advantages of atherectomy when compared to balloons (angioplasty
) and stenting are less vessel barotrauma
, no foreign object (stent metal) left in the body and leaving all future options open for the patient at the treated site.
The decision to use which type of device is made by the interventionist, based on a number of factors. They include the type of lesion being treating, the physician's experience with each device, and interpretation of the devices' risks and effectiveness, based on a review of the medical literature.
Directional
Atherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities. It has also been used to treat coronary artery disease, albeit ineffectively.
Procedure
Unlike angioplastyAngioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
and stents, which push plaque into the vessel wall, atherectomy involves removing the plaque burden within the vessel. Increasing the vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
lumen
Lumen (anatomy)
A lumen in biology is the inside space of a tubular structure, such as an artery or intestine...
by removing the plaque burden improves downstream wound healing, reduces claudication
Claudication
Claudication, literally 'limping' , is a medical term usually referring to impairment in walking, or pain, discomfort or tiredness in the legs that occurs during walking and is relieved by rest. The perceived level of pain from claudication can be mild to extremely severe. Claudication is most...
and pushes amputation levels more distal. While atherectomy is usually employed to treat arteries
Artery
Arteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
it can be used in vein
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
s and vein grafts as well.
Atherectomy falls under the general category of percutaneous
Percutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
revascularization
Revascularization
Revascularization is "a surgical procedure for the provision of a new, additional, or augmented blood supply to a body part or organ." The term derives from the prefix re-, in this case meaning "restoration" and vasculature, which refers to the circulatory structures of an organ.Revascularization...
, which implies re-canalizing blocked vasculature via a needle puncture in the skin. The most common access point is near the groin through the common femoral artery
Femoral artery
The femoral artery is a general term comprising a few large arteries in the thigh. They begin at the inguinal ligament and end just above the knee at adductor canal or Hunter's canal traversing the extent of the femur bone....
(CFA). However, wire and catheter access can occur from wherever a doctor is willing to stick. Other common places are the brachial artery
Brachial artery
The brachial artery is the major blood vessel of the arm.It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa at the elbow. It then divides into the radial and ulnar arteries...
, radial artery
Radial artery
In human anatomy, the radial artery is the main blood vessel, with oxygenated blood, of the lateral aspect of the forearm.-Course:The radial artery arises from the bifurcation of the brachial artery in the cubital fossa. It runs distally on the anterior part of the forearm...
, popliteal artery
Popliteal artery
In human anatomy, the popliteal artery is defined as the extension of the "superficial" femoral artery after passing through the adductor canal and adductor hiatus above the knee...
, dorsalis pedis, and others.
Advantages
The procedure is considered less invasive than endarterectomyEndarterectomy
Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of soft/hardening deposits. It is carried out by separating the plaque from the arterial wall....
, which involves the surgical cut down and removal of plaque from the inner wall of a diseased vessel.
The advantages of atherectomy when compared to endarterectomy include less procedure time, ease of use, faster patient recovery, decreased systemic complications, repeatability in light of new occlusions. It also serves as a chance for non-surgical candidates.
The advantages of atherectomy when compared to balloons (angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
) and stenting are less vessel barotrauma
Barotrauma
Barotrauma is physical damage to body tissues caused by a difference in pressure between an air space inside or beside the body and the surrounding fluid...
, no foreign object (stent metal) left in the body and leaving all future options open for the patient at the treated site.
Atherectomy Devices
There are four types of atherectomy devices: orbital, rotational, laser, and directional.The decision to use which type of device is made by the interventionist, based on a number of factors. They include the type of lesion being treating, the physician's experience with each device, and interpretation of the devices' risks and effectiveness, based on a review of the medical literature.
Directional