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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

  • 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. 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.

  • You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.

  • 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.

Getting Ready

The week before your atherectomy:

  • Ask your caregiver for instructions on whether you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.

  • Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.

  • Arrange for a family member or friend to drive you home after your atherectomy. Do not drive yourself home.

  • Dye may be used during your atherectomy to let caregivers see the arteries better. People who are allergic to shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.

  • You may be asked to stop smoking. Ask your caregiver for more information if you have trouble stopping smoking.

  • You may need to have an electrocardiogram, chest x-ray, and blood tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your atherectomy:

  • You may given aspirin or blood thinners.

  • Ask caregivers about directions for eating and drinking.

The day of your atherectomy:

  • Write down the correct date, time, and location of your procedure.

  • Ask your caregiver before taking any medicine on the day of your atherectomy. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.

  • Do not wear contact lenses the day of your atherectomy. You may wear your glasses. Wear socks to help you stay warm.

  • If you are staying in the hospital after your atherectomy, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.

  • Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • An anesthesiologist may talk to you before your atherectomy. This caregiver may give you medicine to make you sleepy during the procedure.

  • You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do an atherectomy. It also explains the problems that may happen with the procedure, and your choices. You may also be asked to sign a consent form for bypass surgery in case problems are found during this procedure. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

  • You may be given medicine to help you relax or make you drowsy. You will be taken to the room where the atherectomy will be done. There may be large x-ray machines and other equipment inside the room. X-rays with a TV screen will be used to do the atherectomy. You may be moved into a special bed. 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, and the area will be shaved if that is needed.

  • Caregivers will inject medicine called local anesthesia to numb the area where the catheter will go in. A small incision (cut) 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 any pain or chest tightness during the atherectomy. A pulmonary artery line is a type of central line catheter that may be placed. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube goes through your heart and into a blood vessel that goes to your lungs. This catheter can be used to monitor you during the procedure.

After your atherectomy:

  • The catheter inserted for the procedure will be taken out of the artery and a tight pressure bandage will cover 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. You may need to put your fingers over the incision area if you have to cough or sneeze. Ask your caregiver for more information on ways to prevent bleeding after atherectomy.

  • You may be taken to a room where you can rest until you are awake. You may need to lie flat and still in bed for a few hours. Do not get out of bed until your caregiver says it is OK.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your atherectomy appointment on time.

  • You have questions or concerns about your atherectomy.

  • You have a fever.

Seek Care Immediately if

You have any of the following signs of a heart attack:
  • Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns

  • Discomfort or pain in your back, neck, jaw, stomach, or arm

  • Trouble breathing

  • Nausea or vomiting

  • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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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