Once we've decided that a patient is going to undergo an angiogram, we use images to determine the extent of any blockages that might be present in the lower extremities. We assess what type of plaque is present, how much plaque has built up, and whether or not this is calcified. The more plaque that is built up, the more likely that we would decide to use an atherectomy device, shaving away the plaque, in order to create a channel. Our balloons and potential stents will be more effective once we've debulked some of the plaque. There are instances where there is not much plaque, but you still have a narrowing, causing issues with wound healing or the ability to walk. If there's not a lot of plaque burden, then angioplasty by itself will be sufficiently effective in opening up those areas that are narrowed. Depending on what we see on the initial diagnostic images that we take, we will make the decision on whether or not we're going to use atherectomy, and shave away those plaques, or if we can just go straight to angioplasty or a possible stent placement if needed.
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