Nd:Yag laser-assisted balloon angioplasty of superficial femoral artery occlusions in a diabetic population.
Laser-assisted balloon angioplasty (LABA), has potential as a treatment modality for re-establishing flow in occluded arterial segments. The objective of this retrospective review is to summarize the results of LABA of totally occluded superficial femoral arteries in 33 limbs among 32 diabetic patients. Indications for vascular intervention in this population included disabling claudication in 15 (45.6%), rest pain in 9 (27.2%), and tissue loss in 9 (27.2%) limbs. The review of preoperative arteriograms allowed for the division of limbs into three groups by occlusion length as follows; less than 5 cm, between 5 and 10 cm, and greater than 10 cm. Overall initial success rate was 21 of 33 (63.6%). Nine of ten (90%) occlusions less than 5 cm in length; six of nine (66.7%) occlusions between 5 and 10 cm in length; and six of 14 (42.9%) lesions greater than 10 cm in length were initially successfully recanalized. Overall cumulative patency rate at 1 year was 22.5%. For occlusion lengths less than 5 cm, cumulative patency rates at 1 year and 2 years were 66.4% and 33.2%, respectively. All lesions greater than 5 cm that were initially recanalized, uniformly re-occluded by 1 year. The number of complications (vessel perforation or dissection) increased as lesion length increased. The theoretic advantages of laser energy's ability to recanalize occlusive lesions are lost when coupled with the balloon angioplasty technique, especially in diabetics. Laser-assisted balloon angioplasty in its present form should be considered an investigational tool requiring further technologic refinements and controlled clinical trials.
Field
C K
CK
Department of Surgery, Hahnemann University School of Medicine, Philadelphia, PA 19102-1192, USA.
Matsumoto
T
T
Kerstein
M D
MD
D000328:Adult; D000368:Aged; D017222:Angioplasty, Balloon, Laser-Assisted; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome