Plaque excision for the treatment of infrainguinal arterial occlusive disease.

Lower extremity peripheral vascular disease has a broad spectrum of presentations, ranging from intermittent claudication, rest pain, to limb threatening tissue loss and gangrene. Over the last 10 to 15 years, short focal stenoses or occlusions have been treated using endovascular techniques, but conventional angioplasty and stenting is limited by high restenosis rates especially in longer lesions. Moreover, multilevel, complex disease is still generally considered best managed by surgical intervention. However, with the improvements in atherectomy technology, namely plaque excision and laser plaque ablation, the full spectrum of arterial occlusive lesions may now be addressed by percutaneous means with excellent limb salvage rates. Excisional atherectomy is currently exemplified by the SilverHawk Plaque Excision System, which is available in four sizes for the treatment of all infrainguinal vessels. As the apparatus is advanced, the rotational cutting blade excises a ribbon of plaque that is concurrently collected into a nosecone. Multiple passes are made, during which the blade is directed sequentially toward all quadrants of the vessel lumen. The stenotic lesion is grossly debulked by this technique with the proposed advantage of avoiding the arterial wall barotrauma that hampers the durability of angioplasty and stenting.