ASDIN Original Investigations: How I Do It: Directional Atherectomy for In-Stent Restenosis of a PTFE Arteriovenous Graft


Address correspondence to: Alexander S. Yevzlin, University of Wisconsin Hospitals and Clinics, 3034 Fish Hatchery Road, Suite B, Madison, WI 53713, or e-mail:


We describe the use of directional atherectomy (DA) to restore patency of a thrombosed polytetrafluoroethylene arteriovenous graft with an in-stent restenosis at the venous anastomosis. Technically, the procedure described is not an atherectomy per se, but rather the removal of fibrosis and intimal hyperplasia with sharp endoluminal dissection. Certainly, the operator must be cautious when performing DA directly adjacent to a previously deployed stent. Nevertheless, our report suggests that there may be a role for DA in the treatment of severe, resistant in-stent stenosis. Further investigation is necessary to evaluate the safety and efficacy of the described technique.