Checkup

Shaving Away Peripheral Arterial Disease

The catheter is inserted into the artery and eased toward the blockage site.

Enlarge

Once there the small cutting tool is activated, shaving off the plaque.

Enlarge

The plaque collects in the catheter and is flushed from the body. The process continues until normal blood flow is restored.

Enlarge

Retired insurance executive David Murphy was looking forward to improving his golf game. But continuing pain in his calves made even a stroll to the putting green difficult.

"I couldn't walk more than a half a block without having to stop and rest," Murphy says. "It was pretty frustrating, because I'd been active all my life."

Murphy was diagnosed with peripheral arterial disease (PAD). He came to Mayo Clinic for a minimally invasive procedure called an atherectomy to shave away the plaque lining the inside of blocked arteries in his legs. Today, Murphy walks his golden retriever a mile every morning and rides a stationary bike or works out in the gym every day.

PAD is caused by a buildup of plaque in the arteries supplying blood to the limbs. The buildup restricts and sometimes blocks blood flow through the artery. The result, in about half of all people with PAD, is claudication — pain in the affected limb, most often the calf, during activity. The first line of therapy for PAD is exercise and risk-factor modification. A sedentary lifestyle, smoking and high cholesterol, the same risk factors for coronary artery disease, all increase the odds of developing PAD.

Since the aching pain from PAD goes away at rest, Mayo Clinic vascular surgeon Dr. Albert Hakaim says patients should first try walking every day to the point where pain begins, stop and then continue.

"This allows the body to form small vessels around the blocked arteries and create natural bypasses," he says. "This alone can improve the distance patients can walk before they have the claudication pain."

Doctors may also prescribe one of two drugs approved to treat PAD.

Murphy lost weight and took medication to keep his cholesterol under control but still had pain. Hakaim says there are a few surgical options for people who fail conservative therapy. One option is a surgical bypass that uses a portion of a patient's vein to create a new channel for blood flow. This major operation requires epidural or general anesthesia, a two- to four-day hospital stay and two weeks of recovery. Another surgical option is placing a stent in the blocked artery, but it's usually used only in arteries above the knees.

The newest option is an outpatient procedure called atherectomy that uses a special plaque excision system called SilverHawk. Under local anesthesia, a guide wire and catheter are inserted through the skin into the femoral artery in the groin. The guide wire is advanced through the narrowing or blockage in the artery. A tiny cutting tool, contained in a thin tube, is introduced over the guide wire.

"As it moves up and down the artery, it's shaving very small layers of plaque away," Hakaim explains. "This reestablishes a flow channel in the artery. Stenting expands the artery by pushing the plaque into the artery wall."

Hakaim says people with PAD who fail conservative treatment are considered candidates for atherectomy as long as they have some degree of opening at the origin of the affected artery. This is necessary to insert the guide wire into the blockage. Follow-up studies done up to two years after the procedure show that it's 90 percent successful. Hakaim expects continued follow-up will show that atherectomy will be as good as surgical bypass, which has proven to be 70 to 80 percent successful.

Hakaim performed the procedure on Murphy's left leg in January.

"The surgery was just a piece of cake," Murphy says. "I got up about three hours later and had no pain whatsoever. A month later, I had the other leg done, and it was the same thing. The first thing I did when I got home was walk the dog. I hadn't been able to do that since we got him two years ago."

To request an appointment at Mayo Clinic Jacksonville, call (904) 953-0853 or complete our online appointment request form:

Learn more about the Section of Vascular Surgery at Mayo Clinic Jacksonville.

If you have questions or need more information, send an e-mail to Vascular Surgery.