Status of peripheral atherectomy.

So far, all atherectomy devices have failed to reduce the restenosis rate of standard balloon angioplasty. Despite actual removal, debulking, and even polishing of the atherosclerotic intima, the arterial wall trauma invariably incites intimal hyperplasia. Until the problem of restenosis can be solved, atherectomy will be limited to those instances when balloon angioplasty is ineffective or contraindicated. Each device has its own peculiarities. We prefer to use the Simpson catheter for eccentric lesions in the iliofemoral or femoropopliteal regions, the Auth Rotablator for short lesions in the infrageniculate vessels, and the TEC for longer lesions in the femoropopliteal regions. Adjunctive balloon angioplasty may or may not be required. Ahn and Moore have illustrated specific clinical strategies for peripheral atherectomy.