Laser in infrapopliteal and popliteal stenosis 2 study (LIPS2): Long-term outcomes of laser-assisted balloon angioplasty versus balloon angioplasty for below knee peripheral arterial disease.
BACKGROUND
Laser-assisted balloon angioplasty (LABA) has been shown to be more effective in achieving angiographic success for treatment for below knee peripheral artery disease (PAD) compared with balloon angioplasty alone(BA). However, long-term outcomes of LABA compared with BA for popliteal and infrapopliteal PAD are unknown.


METHODS
We evaluated data on 726 patients undergoing LABA (n = 395) and BA (n = 331) for popliteal and infrapopliteal PAD retrospectively at a single center (2007-2012). Outcomes included long-term ipsilateral major limb amputation, revascularization and mortality (median follow-up = 36 months).


RESULTS
Baseline features were similar in two groups with the exception of more TASC-D lesions (92.4 vs. 66.5%; P < 0.0001) and chronic total occlusions (86.4 vs. 49.5%; P < 0.0001) in LABA group. Angiographic success was higher in LABA compared with BA (97.7 vs. 89.2%; P < 0.0001). Ipsilateral major limb amputation (4.1 vs. 5.1%, P = 0.48) and repeat revascularization (25.1 vs. 23.3%, P = 0.47) were similar in LABA and BA patients despite unfavorable baseline angiographic characteristics in the former. Compared with BA, death was more frequently in LABA group (35.2 and 26.3%, P = 0.01), a reflection of higher comorbid conditions in this group (adjusted HR 1.05, 95% CI 0.79-1.39).


CONCLUSIONS
Despite worse baseline angiographic characteristics compared with BA, LABA was associated with higher angiographic success and similar ipsilateral major amputation, repeat revascularization, and long-term mortality. Future randomized clinical trial should evaluate the efficacy of LABA compared with BA (particularly drug-eluting) in improving limb salvage and reducing repeat revascularization in these high-risk PAD patients.
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Chatchawan
C
Piyaskulkaew
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Kesav
K
Parvataneni
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Hussein
H
Ballout
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Susan
S
Szpunar
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Tarun
T
Sharma
Wake Forest Baptist Hospital, Winston-Salem, North Carolina.
Mohamed
M
Almahmoud
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Thomas
T
LaLonde
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Thomas
T
Davis
Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina.
Rajendra H
RH
Mehta
St. John Hospital and Medical Center, Detroit, Michigan (LIPS2 Study Group).
Hiroshi
H
Yamasaki
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017222:Angioplasty, Balloon, Laser-Assisted / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D003251:Constriction, Pathologic; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply*; D023821:Limb Salvage; D008297:Male; D008824:Michigan; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000503:physiopathology; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
balloon angioplasty; laser; peripheral arterial disease