Applications and limitations of laser-assisted angioplasty.
Laser-assisted angioplasty is rapidly evolving into a promising adjunct to or replacement for standard vascular procedures. A protocol was devised to evaluate the technique in a non-selected, consecutive patient population to define the applications and limitations of the technique. In a 12-month period, 358 lower-limb atherosclerotic lesions were treated with laser/balloon angioplasty [percutaneously (52%) or open (48%)] in 206 consecutive patients. Overall, the laser/balloon technique recanalised 234 lesions (65% laser success), judged clinically effective by a greater than 0.15 improvement in the ankle/brachial index and elimination of symptoms. Operative complications included: perforation (15, 4.2%); thrombosis (16, 4.5%); spasm (5, 1.4%); and false aneurysm at the puncture site (7, 2.0%). Of the 124 failures (35%) categorised for analysis, the most common cause was inability to cross the lesion in 20 cases. This experience has identified three significant clinical limitations to successful laser recanalisation: calcification, inadequate distal circulation, and inability to control restenosis/reocclusion (collapsible lesions and accelerated plaque deposition). Further research is needed to determine if thermal injury seriously compromises the safety and long-term outcome of laser-assisted angioplasty.
Diethrich
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Department of Cardiovascular Surgery, Arizona Heart Institute, Phoenix 85064.
Timbadia
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Bahadir
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011182:Postoperative Care; D012008:Recurrence; D014654:Vascular Patency