Do you sometimes feel pain, tingling, or just a feeling of numbness in your legs when you walk? Do your legs start to hurt after walking for a short distance, and the pain subsides after you stand still for a while? Then one of the main reasons for this could be that the veins that carry blood to your legs have become clogged with fat. We call this condition Peripheral Artery Disease, or PAD for short. So today we are talking about a special and very advanced treatment method that cleans out these clogged veins and restores blood flow. It is called Atherectomy.
Simply put, what is Atherectomy?
Just as a water pipe in our house gets clogged with dirt and rust over time, fatty substances like cholesterol can also build up in our body's arteries over time. We call this layer of fat that builds up 'plaque' . This layer of plaque gradually thickens and reduces the space inside the vein. To be precise, it narrows the vein. In medicine, we call this process Atherosclerosis . So PAD is the condition of Atherosclerosis that causes the veins in the limbs, especially the legs, to become blocked.
Atherectomy is a procedure where a very fine tube (catheter) is inserted into a blocked artery and, using a small blade or laser beam at the end of the tube, the hardened plaque is cut and scraped away. It's like cleaning out a small piece of dirt stuck inside a pipe with a special tool.
After this is done, the blockage in the artery is removed, and blood can flow freely. Sometimes, after removing this fatty layer, doctors may perform an angioplasty to keep the artery open, either by inserting a balloon or a stent .
What are the main types of atherectomy treatment?
There are several main types of atherectomy treatment, depending on the device used to remove this plaque layer. Your doctor will choose the method that is most suitable for you based on factors such as the type of blockage in your artery and the nature of the plaque layer.
| Name of the treatment method (Type of Atherectomy) | How it Works |
|---|---|
| Excisional Atherectomy | This involves cutting and removing the plaque layer to one side with a fine-bladed instrument. |
| Laser Ablation Atherectomy | As the name suggests, this uses a high-energy laser beam to dissolve, vaporize, and remove the plaque layer. |
| Orbital Atherectomy | This is like removing rust with sandpaper. A device with a diamond tip that rotates at high speed is used to scrape away and pulverize the plaque layer. |
| Rotational Atherectomy | In this case, a device with several small blades that rotate at high speed is used to cut, crush, and remove the plaque layer. |
What should I do before this treatment?
Before your doctor decides to perform this treatment, he or she will order several tests to see how much your veins are blocked and exactly where they are.
- Angiography: This involves injecting a special dye into your blood vessels and taking X-ray images of the blood flowing through them. This allows you to clearly see any blockages.
- Vascular Ultrasound: This is like a regular scan. It uses sound waves to measure the speed of blood flow in the veins and detect blockages.
Based on the results of these tests, your doctor will decide whether you are suitable for Atherectomy. The doctor will then give you clear instructions on how to prepare for the treatment.
- Food and Drink: You may be asked to refrain from eating or drinking for a few hours before treatment.
- Medications: It's important to tell your doctor about any other medications you're taking, especially blood thinners (anticoagulants) or aspirin. You may be asked to stop taking them for a few days.
When you go to the hospital on the day of your treatment, you will be given a hospital gown and a thin tube will be inserted into a vein in your arm to give you anesthesia. Don't worry, all of this is done so that you don't feel any discomfort or pain.
How does the treatment work?
Okay, now let's see how this treatment is actually done. This is not a major surgery, so it doesn't make a big incision in your body.
1. First, you will be given a numbing medicine and a sedative to make you feel a little intoxicated. So you won't feel any pain, but you will be conscious.
2. Then, the doctor will make a small incision in your skin to insert a thin tube (catheter) into one of your veins (usually in your groin or wrist).
3. Next, the tube is carefully guided through the vein, under X-ray guidance, and sent to the site where the plaque has accumulated and is blocked.
4. Finally, the special device (blade, laser, or rotating tip) at the end of the tube is activated, the plaque layer is cut, scraped away, and the pieces are removed through the tube.
This may need to be done several times until blood flow is fully restored. The entire process usually takes about two hours.
What happens after treatment?
After the treatment is successfully completed, you will need to lie in bed for a few hours (usually 4-6 hours) to prevent bleeding from the catheter insertion site. During this time, the nurses will regularly check your blood pressure, pulse, and heart rate.
Most of the time, this is done as an outpatient procedure, meaning you can go home the same evening. However, sometimes, depending on your condition, you may need to stay in the hospital for a day.
You can usually return to your normal activities within a few days. However, since everyone's recovery time is different, it's best to ask your doctor about the best time to resume your activities.
Benefits and risks of atherectomy treatment
As with any medical procedure, atherectomy has its benefits and some very minor risks. It is important to be aware of these.
| Advantages | Risks/Complications |
|---|---|
| Provides immediate relief from PAD symptoms (such as leg pain). | When you cut the plaque, a small piece of it can break off and get stuck in another small artery in front of you. |
| This is not a major surgery. Only a small hole is made in the skin. (Minimally invasive) | Sometimes the device can damage the blood vessel, causing a hole. |
| The treatment usually takes a short time, about two hours. | Bleeding or infection may occur at the site of insertion of the tube. |
| You can recover quickly and return to normal life. | There is some chance that plaque will deposit again in the same place. |
But you should remember that these risks are very rare. Experienced doctors are very good at preventing these situations from occurring and managing them if they do occur.
When do you need to talk to the doctor?
When you go home after treatment, it's important to pay attention to any changes in your body. If you experience any of the symptoms below, you should talk to your doctor without delay .
| If you have these symptoms after treatment, inform your doctor immediately. |
|---|
| - Severe, unbearable pain in the treated groin area or leg. |
| - Leg swelling (Edema) . |
| - Redness or a warm feeling in the treated area. |
| - The treated leg feels colder or number than the other leg. |
Atherectomy is a very effective and safe way to treat Peripheral Artery Disease (PAD). If you have these symptoms, don't be afraid to see a doctor and get advice. Thanks to modern treatments like these, we have now been able to successfully deal with these diseases.
Take-Home Message
- Atherectomy is a simple, minimally invasive treatment that scrapes and removes fatty deposits (plaque) that have become lodged in the arteries due to PAD.
- Since this is not a major surgery, you can recover quickly and return to normal life.
- As with all treatments, there are small risks, but they are very rare and can be managed by experienced doctors.
- If you experience unusual pain, swelling, redness, or tingling in your leg after treatment, call your doctor immediately .
- Your lifestyle, such as diet and exercise, is very important for the success of this treatment and to prevent relapse.
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