Cleaning out Solid Plaque from Arteries
Calcified Aorta all the white
Peripheral Arterial Disease
This dense white ( XRay opaque) material is becoming the most common stuff that we find blocking peoples arteries and we don't really have an explanation of what is the cause of its development. We know smoking is a major factor and these dramatic changes are effected by abnormal glucose metabolism in diabetes; patients with chronic renal failure are at high risk; there is an association with blood pressure but this may be just a symptom of the degenerating arteries.
There has been a dramatic realisation that what we have been taught for decades about fat and abnormal metabolism is wrong. We were instructed that we were obese because of dietry fat and low fat diets were promoted and cholesterol was treated. Sugar has been found to be a much more significant problem. Fat mainly mono-saturated oils e.g. olive oil comprise 40% of the diet best recommended for cardiac health. (Mediterranean).
Once the dense plaque is calcified there is no evidence that there is any medication that will influence what is there or how it will progress.
If the blockages get to cause symptoms; limiting claudication or threatened tissue, intervention is likely to be necessary.
Endovascular procedures are considered first because of the limited trauma associated with them; and because their functional outcome can be just as good as open surgery in the peripheral vessels.
Standard procedures involve sheath access, wires to act as railroads, balloons to dilate the blockages +/_ drug eluting surfaces. and when appropriate stents. All of these tend to fail when dense calcification is the focus.
The new technology we have to best cope with this dilemma is atherectomy and I consider the most appropriate device we have at present is the Jetstream device and that will be discussed here.