Orbital Atherectomy in the Treatment of Calcified Peripheral Arteries: An Evidence- and Survey-based Position Paper

In India, the adoption of orbital atherectomy (OA) for treating peripheral arterial disease (PAD) remains limited within routine clinical practice, despite increasing evidence supporting its effectiveness in optimizing the outcomes. To address this gap and promote wider integration of OA into endovascular practice, a position statement was developed to provide comprehensive and practical guidance on its appropriate use in peripheral interventions. A survey was conducted among 14 experienced peripheral vascular and interventional specialists across India to capture current clinical practices, first hand experience, and perceptions regarding the use of OA in managing PAD and identify barriers to its adoption. The aggregated survey responses were carefully analyzed alongside a detailed and systematic literature review, which compiled clinical evidence, procedural outcomes, safety profiles, and recent technological advancements related to OA in PAD. By combining real-world insights with the latest scientific data, the resulting position statement synthesizes evidence-based recommendations designed to enhance clinician understanding, encourage standardized use, and ultimately improve patient outcomes through optimized application of OA in PAD management.