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Atherectomy

Atherectomy

The Vascular Surgery team at the University of Michigan is dedicated to providing exceptional patient care in the U-M Cardiovascular Center (CVC), our new state-of-the-art clinical building.

Our vascular surgeons have extensive experience performing Atherectomy for the treatment of peripheral vascular occlusive disease and are continuing to investigate and research new advances for treatment in this area.

What is Atherectomy?

As you age, plaque - a material made of cholesterol, calcium and fibrous tissue can build up along the walls of your arteries. As more plaque accumulates, your arteries narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow or cause irregularities in the normally smooth inner walls of the arteries.

An atherectomy is a procedure in which your vascular surgeon inserts a specialized catheter into a blocked artery to remove a buildup of atherosclerotic plaque from within the vessel. The catheter contains a sharp rotating blade, grinding bit, or laser filament, as well as a collection system that permits your surgeon to remove the plaque from the wall of the vessel and collect or suction any resulting debris.

Atherectomy is typically used to treat blockages where angioplasty and stenting cannot be performed. This may be as a result of anatomical factors, the location of the blockage, the hardness of the plaque, or other factors. More commonly, atherectomy is used as a complement to angioplasty and stenting, removing significantly hardened blockages, and allowing for the insertion of a balloon and stent. A stent is a small metal device that helps to prevent a blockage from re-forming at the same location.

A variety of catheters can be used for this procedure, with the type of catheter being used dependant on the nature of the blockage being treated.

Conditions Treatments
Atherectomy (also known as: percutaneous atherectomy, extirpative atherectomy, ablative atherectomy, percutaneous peripheral atherectomy, laser atherectomy, excimer laser atherectomy) Atherosclerotic blockages of the peripheral vasculature

Who is a good candidate for Atherectomy?

You are a good candidate for an atherectomy if you have severe narrowing of peripheral arteries that cannot be easily treated with angioplasty and stenting, cannot have a bypass surgery, or if the nature of the blockage indicates that atherectomy should be used as a preliminary step to angioplasty and stenting.

U-M vascular surgeons who perform Atherectomy

For details about education, experience, and specialty in this clinical area, please visits these physician profile pages:

How do I prepare for Atherectomy?

Your doctor will give you detailed instructions as to how to prepare for the procedure. These may include a suggestion to eat a light meal the night before the procedure and to not eat or drink anything after midnight before the procedure. If you regularly take any important medicines, your physician may ask you to take them on the day of surgery with a sip of water.

Follow your doctor's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

Other Considerations

  • Plan for your care and transportation after the procedure and during recovery at home.
  • Before the procedure tell your health care provider if you have had any kidney problems or reactions to iodine-containing foods or chemicals, such as seafood or kidney contrast dye.
  • Before surgery, your health care provider will ask you to sign a consent form for angioplasty, bypass surgery, and angiography. Angiography is an X-ray study of the blood vessels using dye. This consent form is needed in case problems arise during the atherectomy and emergency surgery is needed.
  • You will have blood tests, and an electrocardiogram (ECG) before the procedure.
  • Someone at the hospital will shave and wash the area where the catheter will be inserted (arm or groin) to help prevent infection.

What happens during the procedure?

You will be given a local anesthetic to numb the area where the catheter will be inserted. You will stay awake during the procedure, but be sedated for comfort.

Your vascular surgeon will thread a thin guide wire into the blocked artery through a needle inserted into a blood vessel in your groin. Dye is injected into the artery and X-rays are taken while the dye moves through your artery. Using these x-ray images, an atherectomy catheter will be advanced to the location of the blockage. The catheter is a thin tube inserted into a blood vessel in your groin and contains a cutting blade, grinding device, or laser filament, that will be used to remove the blockage. In addition, the catheter also contains a collection or suctioning system used to remove any debris as a result of the procedure. Once the blocked portion of the vessel opens and blood flow is improved, your surgeon may place a metal device called a stent at the location of the blockage to reduce the likelihood of another blockage from forming. The catheter is then removed.

What happens after the procedure?

You will go back to your hospital room and rest in bed for 12 to 24 hours. You will most likely be able to go home the next day. You can usually resume normal activity within a day or two. You may be temporarily placed on a medication called Plavix.

Many people with successful atherectomy have good long-term results. Some people's arteries may narrow again which may require a repeat of the procedure. This usually happens within 3 to 6 months of having the procedure.

What are the risks?

  • You may have an allergic reaction to the local anesthetic or x-ray dye.
  • You may bleed a lot and need medicine or a blood transfusion.
  • The artery may be damaged. For example, the artery might be perforated during the procedure. Emergency bypass surgery or repair of the perforation (hole) would then be needed.
  • There is a risk of injury to the groin where the catheter was inserted.
  • The blockage may come back after 3 to 6 months.
  • Although rare, a procedure involving the brain arteries could cause a stroke.

There is risk with every treatment or procedure. Talk to your surgeon for complete information about how the risks apply to you.

How can I take care of myself following surgery?

  • Do not smoke.
  • Eat a healthy diet that is low in fat and cholesterol.
  • Exercise according to your health care provider's recommendation.
  • Keep your appointment for your scheduled post-discharge office visit.

When should I call my health care provider?

Call your health care provider right away if:

  • You have chest pain.
  • You have constant or worsening pain or numbness in your arm or leg.
  • You have a fever.
  • You have shortness of breath.
  • Your leg becomes blue and cold.
  • You have bleeding, excess bruising, or a lot of swelling where the catheter was inserted.

Make an appointment or contact us for more information.