Peripheral laser angioplasty with pulsed dye laser and ball-tipped optical fibres.
Laser angioplasty with the pulsed dye laser and integral ball-tipped optical fibres was used for primary treatment of occlusive femoropopliteal vascular disease in 26 limbs of 24 patients, all of whom warranted operative intervention. 19 had "critical ischaemia", 8 had pedal ulceration, and 4 had distal gangrene. The delivery device consisted of the laser fibre loaded retrogradely into a standard 6 mm balloon angioplasty catheter, and was introduced through a common femoral artery cutdown in an attempt to recanalise femoropopliteal occlusions of a mean length of 21 cm (range 3-49). Angiographic recanalisation was achieved with a mean energy of 250 J (range 38-727 J) in 23 of the 26 limbs; in each case the channel created by the laser fibre was augmented by balloon angioplasty. Technical failure occurred in 3 patients, due to wall dissection, persistent side-branch entry, and incomplete lesion penetration, respectively. Acute occlusion within 48 h occurred in 2 diabetic patients with very poor run-off and distal gangrene, and early failure occurred in another patient due to inadequate balloon dilatation. 1 patient with segmental tibial disease below a technically successful recanalisation did not show clinical improvement. Several patients had coexisting coronary artery disease, 3 of whom died of myocardial infarction--all with patent femoropopliteal vessels. In the 21 survivors, 14 vessels remained patent at a median of 7 months' follow-up.
Murray
A
A
Department of Medical Electronics, St Bartholomew's Hospital, London.
Wood
R F
RF
Mitchell
D C
DC
Edwards
D H
DH
Grasty
M
M
Basu
R
R
D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D005069:Evaluation Studies as Topic; D005263:Femoral Artery; D005336:Fiber Optic Technology / Q000295:instrumentation*; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D011150:Popliteal Artery; D014652:Vascular Diseases / Q000628:therapy*