Atherectomy

WHAT YOU SHOULD KNOW:

• Atherectomy is a procedure that is done to remove plaques that block the arteries (blood vessels). Plaques are fat, cholesterol, or tissues that are clogged in the inner wall of the arteries. Although arteries are present throughout the body, plaque most often builds up in the arteries of the heart. When plaques build up inside the blood vessels, blood flow may be decreased. With a decreased blood flow, your heart muscles may not get enough oxygen. This can cause angina (chest pain), heart disease, or a heart attack.
  
  
• Caregivers use a catheter (long, thin, bendable tube) to cut, shave, or dissolve the plaques that are blocking the arteries. This reduces the narrowing and increases blood flow back to the heart muscles.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Without treatment, your symptoms such as trouble breathing, pain with walking, tiring easily, and angina may worsen. A greatly reduced blood flow may lead to a heart attack which could be serious and life-threatening.
  
  
• Problems that may happen after atherectomy include bleeding from the incision, or infection. The blood vessel used for the procedure may tear, causing a large amount of blood loss. During atherectomy, problems that may happen include a sudden closure of the blood vessel. This decreases the blood flow further and may lead to a heart attack. An emergency coronary artery bypass graft surgery (CABG) may need to be done. Ask your caregiver if you have questions about atherectomy.

WHILE YOU ARE HERE:

Before your atherectomy:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Medicines: You may have any of the following:
  
  
  • Aspirin: This is medicine that may be given to help thin the blood to keep blood clots from forming.
    
    
  • Calcium channel blockers: These medicines relax and open up blood vessels in your body.
    
    
  • Nitroglycerin: This medicine may also be called nitro. Nitroglycerin opens the arteries to your heart so the heart gets more oxygen. Nitroglycerin can be given in an IV, by mouth, or put on your body as a patch or paste.
    
    
  • Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
  
  
• Tests: You may need any of the following:
  
  
  • Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
    
    
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Local or monitored anesthesia: This is a shot of numbing medicine put into the skin where you will have surgery. You may still feel pressure or pushing during surgery but you should not have pain. With local anesthesia, you will be fully awake during the procedure. With monitored anesthesia care, you will also be given medicine through an IV. This medicine keeps you comfortable, relaxed, and drowsy during the procedure.

During your atherectomy:

• X-rays with a TV screen will be used to do the atherectomy. Caregivers will choose an artery to be used for the procedure, which is usually in your groin, arm, or wrist. Soap will be used to clean the area. If an artery in the groin is chosen for the procedure, caregivers may shave the area. This is done to see the area better and help prevent infection. Sheets will be put over you to keep the atherectomy area clean.
  
  
• A small incision will be made through which a catheter will be inserted. The catheter is then gently pushed into the artery. You will be given an iodine dye through the IV to better see the area that is blocked. This may give you a warm feeling or a hot flash. Caregivers will then choose the type of instrument to use in clearing the plaque. You may hear a whirring noise, like a dentist's drill. You may also feel pushing movements as your caregiver cuts through the plaque. Tell your caregiver if you feel pain or chest tightness during the procedure. After the plaque is removed, the catheter is taken out of the artery, and a tight pressure bandage will be secured over the incision. Caregivers may place a small sandbag over the bandage to put pressure and prevent bleeding. The sandbag may stay in place for a few hours.

After your atherectomy: You may be transferred to a recovery room or a cardiac care unit after your atherectomy. Caregivers will take your vital signs every 15 minutes for 1 to 2 hours. The pulses in your feet will also be checked often. If you need to cough or sneeze, you may be asked to put your fingers over the area where the catheter was inserted. Caregivers will watch you closely for problems that can happen after an atherectomy. Tell your caregiver if you have any of the following signs or symptoms:

• You have chest pain.
  
  
• Your leg feels cold or turns a different color, or if it hurts or feels tingly or numb.
  
  
• Your groin is swollen or bleeding.
  
  
• You have pain in your back, thigh, or groin.
  
  
• You feel dizzy and nauseated (upset stomach), or if you start to sweat a lot.

• Activity: You will need to lie flat and still in bed for a few hours. Tell your caregiver if you get tired of lying on your back. Caregivers will help you log-roll from side to side. If an artery in your groin was used for the procedure, you must keep your leg straight until your caregiver tells you it is OK to bend it. Your caregiver will also tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy after getting up, sit or lie down right away and call your caregiver.
  
  
• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.
  
  
• Monitoring: Caregivers may check for your pulses on your legs or feet. This may help the caregiver to learn if you have problems with blood flow after your atherectomy. You may also have the following:
  
  
  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
    
    
  • Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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