Complications of Laser-Assisted Angioplasty: Recognition, Classification and Treatment

Abstract

No adequate reports from signifi cant patient populations exist on the nature and extent of complications from peripheral laser-assisted angio plasty. To define and enumerate these adverse reactions, data were col lected from 770 procedures per formed on 400 patients in a sixteen- month period. Arteries treated were: 133 iliac (17%), 418 femoral (54%), 121 popliteal (16%), 73 tibial/pero neal (9%), and 25 grafts (3%). Complications, similar to those of standard angioplasty, were identified and classified according to cause: la ser, access method, or the angioplasty procedure with its attendant equip ment (balloons, etc). The types of morbidity observed were: perfora tion/dissection (54 cases, 7%), acute thrombosis (38, 5%), spasm (5, 0.7%), false aneurysm at the punc ture site (15, 2%), embolism (1, 0.1%), and hematoma (115, 15%). Because perforation is the most significant intraoperative complica tion, a standardized system has been devised to bring uniformity to its doc umentation and reporting. The three-part classification is based on the arterial pathology producing the probe's deviation and on the ramifi cations of the aberrancy. In addition to recognition and classification, prudent treatment of an evolving complication can often salvage the procedure. Treatment modalities for the common complica tions and preventive measures to avert them have been identified and incorporated into the treatment pro tocol.