Name of the Procedure:

Transluminal Peripheral Atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel

Summary

Transluminal peripheral atherectomy is a medical procedure designed to remove plaque from the iliac artery using a catheter-based approach. It can be performed either through an open surgical method or percutaneously (through the skin) with the aid of radiological imaging for guidance.

Purpose

This procedure addresses peripheral artery disease (PAD), specifically within the iliac artery. The primary goal is to restore proper blood flow to the lower extremities by removing blockages caused by plaque build-up. This can alleviate symptoms such as leg pain, improve mobility, and reduce the risk of severe complications like limb loss.

Indications

• Intermittent claudication (leg pain with walking)
• Critical limb ischemia (severe blockage reducing blood flow)
• Non-healing ulcers or sores on the lower extremities
• Failed previous treatments like angioplasty or stenting
• Significant narrowing of the iliac artery diagnosed through imaging studies

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests, imaging studies, and assessments of overall health will be conducted.
• Medications may need to be adjusted, particularly blood thinners and antiplatelets.
• Hydration instructions might be given to improve kidney function post-contrast dye use.

Procedure Description

1. The patient is positioned on an examination table, and the access site (often the groin) is sterilized.
2. Local anesthesia or mild sedation is administered.
3. A catheter is inserted into the access site and guided to the iliac artery using fluoroscopy (x-ray guidance).
4. The atherectomy device, which may involve cutting, shaving, or vaporizing the plaque, is deployed through the catheter.
5. Radiological supervision and interpretation guide the device to ensure complete and precise plaque removal.
6. Once plaque is removed, the catheter is withdrawn, and the access site is closed.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The procedure is performed in a hospital, particularly in a catheterization lab or a specially-equipped radiology suite.

Personnel

• Vascular surgeon or interventional radiologist
• Radiology technician
• Nursing staff
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common Risks: Bruising, bleeding at the access site, infection.
• Rare Complications: Vessel perforation, allergic reaction to contrast dye, blood clots, embolism.

Benefits

• Improved blood flow to the lower extremities
• Relief from pain and symptoms associated with PAD
• Enhanced mobility and quality of life
• Reduced risk of severe complications like limb amputation

Recovery

• Patients are typically observed in a recovery area for a few hours.
• Instructions may include avoiding strenuous activities for a few days, monitoring the access site, and continuing prescribed medications.
• Follow-up appointments are necessary to monitor the success of the procedure and manage ongoing care.

Alternatives

• Angioplasty with or without stenting
• Bypass surgery
• Medications to manage PAD symptoms
• Lifestyle changes (exercise, diet, smoking cessation)

Pros and Cons of Alternatives:

• Angioplasty is less invasive but may have higher restenosis rates.
• Bypass surgery is more invasive with longer recovery time but may offer better long-term results.
• Medications and lifestyle changes are non-invasive but may not be sufficient for severe cases.

Patient Experience

• During the procedure, patients may feel pressure or mild discomfort but should primarily be pain-free.
• Post-procedure, there may be minor soreness at the access site.
• Pain management will include over-the-counter pain relievers and instructions for care to ensure comfort and swift recovery.