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  • The Jury Is Still Out on Atherectomy

    Peripheral artery disease of the lower extremities is a prevalent disorder affecting mainly the elderly population, especially those with risk factors such as diabetes mellitus, history of smoking, hyperlipidemia, hypertension, and those with a positive family history. Patients are commonly asymptomatic, but may present with intermittent claudication, with a subset of patients presenting with critical limb ischemia (rest pain, gangrene, ulcerations). Current first-line therapy for those with claudication includes medical therapy (i.e., antiplatelet, statin therapy), risk factors control (i.e., management of hypertension, diabetes), smoking cessation, and enrollment in a supervised walking program. According to current American College of Cardiology/American Heart Association (ACC/AHA) 2017 guidelines, a revascularization approach is indicated in patients who experience claudication that limits quality of life despite medical therapy and an exercise program, and in patients with critical limb ischemia (CLI), with the objective to eliminate rest pain, minimize tissue loss, help with wound healing, and improve quality of life.

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