Role of Atherectomy Devices in the Treatment of Lower Extremity Peripheral Arterial Disease

Introduction Atherosclerosis is a systemic disease affecting all major vascular beds. Risk factors for atherosclerosis, and therefore, for PAD, include active smoking, advance age, dyslipidemia, diabetes mellitus, and hypertension. Due to continuous increase in aging population and diabetes, incidence of peripheral arterial disease will continue to increase. While atherosclerotic coronary disease usually have focal lesions and can successfully be treated with balloon angioplasty or stent. Lower extremity peripheral arterial occlusive disease however, poses a unique challenge to traditional angioplasty-based endovascular therapies. The diffuse nature of lower extremity atherosclerotic disease, the presence of chronic total occlusions, poor distal runoff, and the presence of critical limb ischemia all have contributed to the disappointing results of balloon angioplasty for complex infrainguinal arterial disease. This results in development of a host of new technologies such drug eluting balloon and atherectomy in an attempt to improve the safety and effectiveness of percutaneous revascularization for lower extremity peripheral arterial occlusive disease. This review summarizes the available atherectomy devices their mechanism of action and literature supporting their use. Peripheral arterial disease (PAD) comprises the vascular diseases caused primarily by atherosclerosis and thromboembolic pathophysiological processes that alter the normal structure and function of the aorta, its visceral arterial branches, and the arteries of the lower extremity [1]. The incidence of PAD is high as 12-15 million adults living in USA suffer from PAD [2]. Patients with PAD can present with a myriad of symptoms, or can remain asymptomatic despite having advanced disease. PAD is a powerful independent predictor of coronary artery disease and cerebrovascular disease. In the Coronary Artery Surgery Study (CASS) registry, for patients with known CAD, the presence of PAD increased cardiovascular mortality by 25% during 10 years of follow-up [3]. In last two decades, significant advances have been made in the treatment of PAD especially involving the lower extremities. Treatment of lower extremity PAD includes medical therapy with risk factor modifications, endovascular therapy, and surgery. Endovascular treatment of PAD includes percutaneous transluminal angioplasty (PTA), stenting, and atherectomy. In this article we will discuss role of atherectomy in the treatment of PAD. The atherosclerotic process in the lower extremity is usually diffuse. Vessels are calcified, have poor runoff, and are often chronically occluded. Balloon angioplasty alone may not result in long-term patency [4]. In addition PTA could result in barotrauma, intimal/medial hyperplasia, and dissection. Stenting, on the other hand, precludes the use of surgical bypass at a future stage if deployed on particular anatomic locations. Atherectomy devices have advantage of reducing the atherosclerotic burden without causing barotraumas or precluding future bypass surgery. Citation: Syed Mashood Ahmed. “Role of Atherectomy Devices in the Treatment of Lower Extremity Peripheral Arterial Disease”. EC Cardiology 1.1 (2015): 1-9.