title: Wireless laser-assisted angioplasty of the superficial femoral artery in patients with critical limb ischemia who have failed conventional percutaneous revascularization.
abstract: Percutaneous revascularization has become an effective treatment for patients suffering from chronic critical limb ischemia (CLI) due to chronic atherosclerotic obstructions, including total occlusions. Unlike other vascular beds, total chronic occlusions of the femoropopliteal arteries are frequently found in patients with severe claudication or CLI. As a consequence, patients with long chronic total occlusions of the femoropopliteal arteries are generally not considered optimal candidates for percutaneous revascularization and are frequently referred for surgical revascularization. In the present study, we sought to evaluate the feasibility, safety, and outcome of a modified wireless laser ablation technique to recanalize total occlusions in patients with CLI who had failed conventional percutaneous techniques for limb salvage. Procedural success, complications, actuarial freedom of limb loss, and surgical revascularization were evaluated in 25 patients after a mean follow-up of 13 +/- 8 months. Procedural success was achieved in 21 patients (84%). Actuarial freedom from surgical revascularization or limb loss was 72%. There was one vascular perforation. No deaths or distal embolization occurred. Three patients (12%) required limb amputation during follow-up, whereas four patients (16%) had surgical revascularization in the presence of feasible vascular targets. Limb salvage was achieved in 88% of patients when laser recanalization was combined with surgical revascularization. These results suggest that the use of laser ablation is safe and facilitates angioplasty and stenting in patients with CLI that failed conventional endovascular revascularization. This technique might prevent limb loss in patients with CLI due to femoropopliteal total occlusions, particularly in patients with unsuitable anatomy for surgical revascularization.
authors.affiliation: Division of Cardiology, University of Texas Medical School Houston and Memorial Hermann Hospital, Houston, Texas 77030, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Boccalandro
authors.forename: Andreas
authors.initials: A
authors.lastname: Muench
authors.forename: Stefano
authors.initials: S
authors.lastname: Sdringola
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Rosales
mesh_terms: D000368:Aged; D017222:Angioplasty, Balloon, Laser-Assisted / Q000009:adverse effects / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000601:surgery*; D005121:Extremities / Q000098:blood supply* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007511:Ischemia / Q000503:physiopathology / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D012039:Regional Blood Flow; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome