Peripheral Artery Orbital Atherectomy: Principles and Clinical Applications

  • Vinayak SubramanianEmail author
  • Ivy Smith
  • George L. Adams


Peripheral artery disease (PAD) is characterized by the narrowing of arteries of the extremities. Currently, it affects between 8–12 million Americans and over 200 million people worldwide, and has emerged as a significant global public health concern [1]. The burden of this disease is partly due to the rise in epidemics of diabetes, renal insufficiency, and an aging population, all of which increase the risk of developing vascular disease [2, 3, 4]. The clinical presentation of PAD is broad, ranging from being asymptomatic, increased severity to intermittent claudication with activity, and, at its worst, critical limb ischemia (CLI), which is characterized by rest pain and/or non-healing ulcers. CLI patients often face the morbid prospect of limb amputation due to a non-healing ulceration. Not only do these patients face the prospect of losing their limb but with this they lose their independence and may even lose their life. Patients undergoing amputation have a mortality of 50% at 5 years and 70% at 10 years [5].


  1. 1.
    Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116(9):1509–26.CrossRefPubMedGoogle Scholar
  2. 2.
    Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47.CrossRefPubMedGoogle Scholar
  4. 4.
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–57.CrossRefPubMedGoogle Scholar
  5. 5.
    Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR, Tasc II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(1):S1–S75.CrossRefPubMedGoogle Scholar
  6. 6.
    Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB. Impact of runoff on superficial femoral artery endoluminal interventions for rest pain and tissue loss. J Vasc Surg. 2008;48(3):619–26.CrossRefPubMedGoogle Scholar
  7. 7.
    Bishop PD, Feiten LE, Ouriel K, Nassoiy SP, Pavkov ML, Clair DG, Kashyap VS. Arterial calcification increases in distal arteries in patients with peripheral arterial disease. Ann Vasc Surg. 2008;22(6):799–805.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mustapha JA, Diaz-Sandoval LJ, Karenko B, Saab F. Atherectomy and critical limb ischemia: a treatment approach for severely calcified vessels. Vascular Disease Management. 2013;10(10):E198–207.Google Scholar
  9. 9.
    Fitzgerald PJ, Ports TA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound. Circulation. 1992;86(1):64–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Suri R, Wholey MH, Postoak D, Hagino RT, Toursarkissian B. Distal embolic protection during femoropopliteal atherectomy. Catheter Cardiovasc Interv. 2006;67(3):417–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Adams GL, Khanna PK, Staniloae CS, Abraham JP, Sparrow EM. Optimal techniques with the diamondback 360 system achieve effective results for the treatment of peripheral arterial disease. J Cardiovasc Transl Res. 2011;4(2):220–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Adams GL, Das T, Lee MS, Beasley R, Mustapha J. Subanalysis of the CONFIRM registries: acute procedural outcomes in Claudicant and critical limb ischemia patients with varying levels of calcification treated for peripheral arterial disease with orbital Atherectomy. J Invasive Cardiol. 2015;27(11):516–20.PubMedGoogle Scholar
  13. 13.
    Lee MS, Mustapha J, Beasley R, Chopra P, Das T, Adams GL. Impact of lesion location on procedural and acute angiographic outcomes in patients with critical limb ischemia treated for peripheral artery disease with orbital atherectomy: a CONFIRM registries subanalysis. Catheter Cardiovasc Interv. 2015;87(3):440–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee MS, Beasley R, Adams GL. Impact of advanced age on procedural and acute angiographic outcomes in patients treated for peripheral artery disease with orbital Atherectomy: a CONFIRM registries subanalysis. J Invasive Cardiol. 2015;27(8):381–6.PubMedGoogle Scholar
  15. 15.
    Dattilo R, Himmelstein SI, Cuff RF. The COMPLIANCE 360° trial: a randomized, prospective, multicenter, pilot study comparing acute and long-term results of orbital atherectomy to balloon angioplasty for calcified femoropopliteal disease. J Invasive Cardiol. 2014;26(8):355–60.PubMedGoogle Scholar
  16. 16.
    Staniloae CS, Korabathina R. Orbital atherectomy: device evolution and clinical data. J Invasive Cardiol. 2014;26(5):215–9.PubMedGoogle Scholar
  17. 17.
    Safian RD, Niazi K, Runyon JP, Dulas D, Weinstock B, Ramaiah V, Heuser R. Orbital atherectomy for infrapopliteal disease: device concept and outcome data for the OASIS trial. Catheter Cardiovasc Interv. 2009;73(3):406–12.PubMedGoogle Scholar
  18. 18.
    Shammas NW, Lam R, Mustapha J, Ellichman J, Aggarwala G, Rivera E, et al. Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: results of the CALCIUM 360 randomized pilot trial. J Endovasc Ther. 2012;19(4):480–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Das T, Mustapha J, Indes J, Vorhies R, Beasley R, Doshi N, Adams GL. Technique optimization of orbital atherectomy in calcified peripheral lesions of the lower extremities. Catheter Cardiovasc Interv. 2014;83(1):115–22.CrossRefPubMedGoogle Scholar
  20. 20.
    Fanelli F, Cannavale A, Gazzetti M, Lucatelli P, Wlderk A, Cirelli C, et al. Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease. Cardiovasc Intervent Radiol. 2014;37(4):898–907.CrossRefPubMedGoogle Scholar
  21. 21.
    Tepe G, Beschorner U, Ruether C, Fischer I, Pfaffinger P, Noory E, Zeller T. Drug-eluting balloon therapy for Femoropopliteal occlusive disease predictors of outcome with a special emphasis on calcium. J Endovasc Ther. 2015;22(5):727–33.CrossRefPubMedGoogle Scholar
  22. 22.
    Zeller T, Baumgartner I, Scheinert D, Brodmann M, Bosiers M, Micari A, et al. Drug-eluting balloon versus standard balloon angioplasty for infrapopliteal arterial revascularization in critical limb ischemia: 12-month results from the IN. PACT DEEP randomized trial. J Am Coll Cardiol. 2014;64(15):1568–76.CrossRefPubMedGoogle Scholar
  23. 23.
    Adams GL, Mustapha J, Gray W, Hargus NJ, Martinsen BJ, Ansel G, Jaff MR. The LIBERTY study: design of a prospective, observational, multicenter trial to evaluate the acute and long-term clinical and economic outcomes of real-world endovascular device interventions in treating peripheral artery disease. Am Heart J. 2016 Apr;174:14–21. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vinayak Subramanian
    • 1
    Email author
  • Ivy Smith
    • 2
  • George L. Adams
    • 3
  1. 1.UNC School of MedicineChapel HillUSA
  2. 2.UNC REX Hospital UNC Health Care SystemRaleighUSA
  3. 3.UNC School of Medicine, Cardiovascular and Peripheral Vascular Research, UNC REX HospitalRaleighUSA

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