title: Laser in infra-popliteal and popliteal stenosis (LIPS): retrospective review of laser-assisted balloon angioplasty versus balloon angioplasty alone for below knee peripheral arterial disease.
abstract: Despite the use of laser technology over the last decade, there are limited data to show its procedural and clinical success in infra-popliteal disease. We hypothesized that laser-assisted balloon angioplasty (LABA) is at least similar or better in procedural and peri-procedural outcomes compared to balloon angioplasty (BA) alone, despite adverse lesion characteristics prior to intervention. Retrospective chart and angiogram review of consecutive critical limb ischemia (CLI) patients who underwent endovascular revascularization in the popliteal or infra-popliteal vessels between 2007 and 2012 with LABA or BA alone. Data from 731 patients revealed that baseline demographics were similar in the LABA (n = 398) and BA group (n = 333) with minor exceptions. More patients in the LABA group had TASC-D lesions (92.5 vs. 66.7 %; P < 0.0001) and chronic total occlusions (CTOs) in both vessel 1 (86.4 vs. 49.5 %; P < 0.0001) and vessel 2 (78.6 vs. 47.8 %; P < 0.0001). Multivariate analysis performed using logistic regression after adjusting for confounding factors showed use of LABA was associated with a 7 times greater likelihood of achieving <50 % residual disease compared to BA alone (OR 7.59, P < 0.0001), and a 5 times greater likelihood of improvement in the infra-popliteal lesion severity score than balloon angioplasty alone (OR 4.77, p < 0.0001). LABA is significantly better at achieving angiographic success and improving lesion severity score in spite of adverse lesion characteristics (more TASC-D lesions and CTOs) compared with BA alone. Our findings suggest that the use of LABA is an endovascular approach that is at least as effective and safe or better compared to BA for the treatment of CLI from complex popliteal and infra-popliteal vascular disease.
authors.affiliation: LIPS study group, St John Hospital and Medical Center, Detroit, MI, USA.
authors.forename: Tejwant
authors.initials: T
authors.lastname: Singh
authors.forename: Mihas
authors.initials: M
authors.lastname: Kodenchery
authors.forename: Surya
authors.initials: S
authors.lastname: Artham
authors.forename: Chatchawan
authors.initials: C
authors.lastname: Piyaskulkaew
authors.forename: Susanna
authors.initials: S
authors.lastname: Szpunar
authors.forename: Kesav
authors.initials: K
authors.lastname: Parvataneni
authors.forename: Hussein
authors.initials: H
authors.lastname: Ballout
authors.forename: Haroon
authors.initials: H
authors.lastname: Chugtai
authors.forename: Douglas
authors.initials: D
authors.lastname: Stewart
authors.forename: Thomas
authors.initials: T
authors.lastname: Lalonde
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods; D017222:Angioplasty, Balloon, Laser-Assisted; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000628:therapy*; D007719:Knee Joint / Q000000981:diagnostic imaging; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome