Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial.
OBJECTIVE
To evaluate the effectiveness of laser-assisted angioplasty for patients with critical limb ischemia (CLI) who were poor candidates for surgical revascularization.


METHODS
A prospective registry at 14 sites in the US and Germany enrolled 145 patients with 155 critically ischemic limbs; the patients were poor candidates for bypass surgery owing to inadequate target vessel or saphenous vein, prohibitive cardiac disease, or significant comorbidities (ASA class 4). Additional comorbid risk factors included diabetes in 66%, hypertension in 83%, previous stroke in 21%, and myocardial infarction in 23%. Endovascular treatment included guidewire traversal and excimer laser angioplasty followed by balloon angioplasty with optional stenting.


RESULTS
Occlusions were present in 92% of limbs. A mean of 2.7+/-1.4 lesions were treated per limb; the total median treatment length was 11 cm (mean 16.2, range 0.2-123). Stents were implanted in 45% of limbs. Procedural success, defined as <50% residual stenosis in all treated lesions, was seen in 86% of limbs. At 6-month follow-up, limb salvage was achieved in 110 (92%) of 119 surviving patients or 118 (93%) 127 limbs.


CONCLUSIONS
Excimer laser-assisted angioplasty for CLI offers high technical success and limb salvage rates in patients unfit for traditional surgical revascularization.
Laird
John R
JR
Washington Hospital Center, Washington, DC 20010, USA, and Herzzentrum, Universität Leipzig, Germany. John.R.Laird@medstar.net
Zeller
Thomas
T
Gray
Bruce H
BH
Scheinert
Dierk
D
Vranic
Mitar
M
Reiser
Christopher
C
Biamino
Giancarlo
G
D000368:Aged; D000671:Amputation, Surgical; D017222:Angioplasty, Balloon, Laser-Assisted / Q000009:adverse effects; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D007866:Leg / Q000098:blood supply* / Q000000981:diagnostic imaging; D023821:Limb Salvage; D008297:Male; D018579:Patient Selection; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011859:Radiography; D015607:Stents; D015996:Survival Rate; D016909:Tibial Arteries / Q000000981:diagnostic imaging