Lower-Limb Atherectomy: Defining the Current Landscape

Treatment of lower-limb disease has continued to progress almost exponentially in design and innovation in the last decade.  The ability to treat long lesions has become normal practice. The data supporting many devices has started to trickle in with the advent of randomized trials comparing stenting with simple balloon angioplasty.  Recently there has been a growth of the data set for atherectomy for this same anatomic location.  

The interest in “leaving nothing behind” seems popular again because of the inherent issues with stent or stent graft failures and the difficulties with repeat intervention.  In many cases an alternative approach for debulking prior to another adjunctive therapy seems appealing.  Whether it is to change the arterial compliance with the rotational and orbiting devices to more destination therapy with directional atherectomy these devices have a role and seem well positioned in the scientific landscape to provide upfront benefit for patients with claudication as well as with critical limb ischemia. 

In this issue of Vascular Disease Management, we have brought together experts in the field of atherectomy to discuss the benefits and scientific data set with regard to all forms of atherectomy as a treatment modality for the lower limb.  Described here will be manuscripts from Jihad Mustapha’s group regarding the use of orbital atherectomy for lower limb revascularization. Ron Caputo will describe Pathway and its uses in the lower limb. My group will describe the usefulness and scientific background for use of directional atherectomy using the SilverHawk device, and Tom Davis will discuss a newer atherectomy device the Phoenix from Atheromed.

I hope this issue will convey the current landscape of debulking strategies and arterial compliance strategies as initial therapies for treatment in patients with lower extremity arterial disease with claudication or critical limb ischemia.  With continued innovation and technical advancements I believe this review of the current status of these devices is remarkably timely and important.