Percutaneous Atherectomy

Percutaneous atherectomy is a procedure in which your vascular specialist inserts a specially equipped catheter through your skin into your blocked artery to remove a buildup of plaque.

The vascular surgeons at UPMC have extensive experience performing percutaneous atherectomy to treat peripheral artery disease.

What Is Percutaneous Atherectomy?

Percutaneous atherectomy is a procedure in which your vascular specialist inserts a specially equipped atherectomy catheter through your skin into your blocked artery to remove a buildup of plaque. Plaque is a substance that can build up inside your artery walls, making them thick and stiff.

The atherectomy catheter contains a sharp rotating blade, grinding bit, or laser that "shaves" away the blocked area inside your artery. The catheter also contains a system that collects or suctions particles of plaque that are dislodged during the removal.

Types of percutaneous atherectomy

Types of percutaneous atherectomy include:

• Rotational atherectomy — Rotational atherectomy catheters have a rotating device at the tip that is used to remove blockages in your arteries.
• Laser atherectomy — Laser catheters have an infrared laser at the tip that dissolves blockages.
• Excisional atherectomy — Excisional atherectomy catheters use a blade that cuts in only one direction.
• Orbital atherectomy — Orbital atherectomy catheters use a sandpaper-like device that spins to remove plaque.

What is the difference between a stent and an atherectomy?

An atherectomy is a procedure to remove plaque from the inside of your arteries and restore blood flow. A stent is a device that is placed inside your artery to hold it open. Your doctor may place a stent to hold your artery open after performing an atherectomy procedure.

Conditions we treat with percutaneous atherectomy

• Peripheral artery disease (PAD).

Why Would I Need Percutaneous Atherectomy?

Percutaneous atherectomy treats blockages that cannot be treated with angioplasty and stenting. It can also be done along with angioplasty and stenting, removing blockages to allow for the insertion of a balloon and stent.

Who’s a candidate for percutaneous atherectomy?

You may be a candidate for percutaneous atherectomy if you are having symptoms of PAD that affect your quality of life or are causing non-healing wounds on your legs or feet.

Alternatives to peripheral atherectomy

• Lifestyle changes.
• Medication.
• Peripheral angioplasty and stenting.
• Peripheral vascular ablation.

What Are the Risks and Complications of Percutaneous Atherectomy?

Peripheral atherectomy is a safe and well-tolerated procedure. However, like all medical procedures, peripheral atherectomy comes with risks, including:

• Allergic reactions.
• Bleeding.
• Blood clots.
• Infection at the incision site.
• Problems with your artery, such as re-narrowing or rupture.

What Should I Expect From Percutaneous Atherectomy?

Before your procedure, your vascular surgeon will conduct a thorough exam and use imaging tests to find the blockages and determine their severity. Imaging tests may include:

• Ultrasound — A test that produces images using sound waves and determines the extent of the narrowed blood vessels and blood flow.
• Cardiac positron emission tomography (PET/CT) — This test detects areas of decreased blood flow in the heart while administering less radiation to patients.

Before: How to prepare for percutaneous atherectomy

Your doctor will explain the percutaneous atherectomy procedure and answer your questions. To prepare for the procedure, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have heart valve disease. You may need to receive an antibiotic before the procedure.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. You may need to stop some of the medications before the procedure.
• Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test before the procedure to determine how long it takes your blood to clot.

On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will need to stay in the hospital overnight after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.

How long does percutaneous atherectomy take?

Percutaneous atherectomy typically takes 1-3 hours, depending on your condition.

During your percutaneous atherectomy

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 will be sedated for your comfort.

During the procedure, your surgeon will:

• Thread a thin guide wire into the blocked artery through a needle inserted into an artery in your groin.
• Inject contrast dye into your artery. X-rays will be taken while the dye moves through your artery.
• Use these x-ray images to guide an atherectomy catheter to the location of the blockage. The atherectomy catheter is a thin tube inserted into an artery in your groin that contains a cutting blade, grinding device, or laser filament that will be used to remove the blockage. In addition, the catheter also will contain a collection or suctioning system used to remove plaque that becomes dislodged as a result of the procedure.

After the blocked portion of the vessel is opened 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 that another blockage will form. The catheter will then be removed.

Recovery after percutaneous atherectomy

After your percutaneous atherectomy, you will go back to your hospital room and rest in bed for 12-24 hours. You will most likely be able to go home the next day.

You can usually resume normal activity within a day or two, but ask your doctor when you can return to work. It is very important that you see your doctor for follow-up visits as recommended.

When to call your doctor about percutaneous atherectomy complications

You should call your doctor if you are experiencing any unusual symptoms, including:

• Pain, redness, bleeding, drainage, or increased swelling at the insertion site.
• Chest pain or shortness of breath.
• Severe pain, coldness, numbness, swelling, or discoloration in the limb where the catheter was inserted.
• A fever of more than 100.0°F or chills.
• Fainting, dizziness, or weakness.

If any of these symptoms are severe, you should dial 911 immediately.

What’s the prognosis after percutaneous atherectomy?

For most patients, percutaneous atherectomy restores blood flow to your limbs and helps to reduce the risk of complications from PAD.

What’s the success rate of percutaneous atherectomy?

Percutaneous atherectomy successfully treats PAD in more than 95 percent of patients.

Why Choose UPMC for Percutaneous Atherectomy?

When you choose UPMC for your percutaneous atherectomy, you will receive expert care from some of the region's most experienced vascular specialists. We use minimally invasive catheter-based techniques to remove blockages in your arteries, restore blood flow, and treat peripheral vascular disease.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.