Excimer laser assisted angioplasty for critical limb ischemia: results of the LACI Belgium Study.
BACKGROUND
The purpose of this study was to assess the safety and efficacy of translating into national practice methodology for infrainguinal excimer laser-assisted angioplasty, for the treatment of critical limb ischemia in poor surgical bypass candidates.


METHODS
A prospective five centre Belgian registry enrolled 48 patients, who presented with 51 chronic critically ischemic limbs (Rutherford category 4, 5 or 6) and were poor candidates for bypass surgery. Treatment included crossing the occlusion or stenosis by conventional guidewire followed by excimer laser angioplasty with, or without, adjunctive balloon angioplasty or stenting. A step-by-step technique was used in cases where the guidewire could not pass the occluded site. The primary endpoint was limb salvage, at 6 months, of the treated limb.


RESULTS
Initial treatment was successful in all 51 limbs. By 6 months there had been six deaths, six minor and four major amputations and further intervention was required in four patients. Among survivors, limb salvage rate at 6 month was 38/42 (90.5%), with freedom from critical limb ischemia in 86%.


CONCLUSIONS
This Belgian study of excimer laser assisted angioplasty, in high-risk patients who were poor candidates for surgical re-vascularisation, had a low incidence of surgical re-interventions and limb salvage rate in excess of 90%.
Bosiers
M
M
Department of Vascular Surgery, AZ St Blasius, 9200 Dendermonde, Belgium. marc.bosiers@pandora.be
Peeters
P
P
Elst
F V
FV
Vermassen
F
F
Maleux
G
G
Fourneau
I
I
Massin
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000800:Angioplasty, Balloon / Q000295:instrumentation; D017222:Angioplasty, Balloon, Laser-Assisted / Q000295:instrumentation; D017073:Atherectomy / Q000295:instrumentation / Q000706:statistics & numerical data; D001530:Belgium; D003131:Combined Modality Therapy; D000075202:Contraindications; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D011446:Prospective Studies; D011859:Radiography; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate; D013673:Technology Assessment, Biomedical