Laser angioplasty for limb salvage: Observations on early results

Abstract

During a 27-month period laser thermal angioplasty (LTA) was attempted in 15 patients who had totally occluded segments of their superficial femoral—popliteal arteries (SFA) with limb-threatening ischemia (rest pain or tissue necrosis). In five patients (33%) laser perforation of the SFA precluded successful angioplasty, and those five patients have been excluded from further analysis. In the remaining 10 patients the prelaser angiogram demonstrated an average SVS/ISCVS runoff score of 7.7 (best possible score, 1; worst possible score, 10). Seven patients (70%) had occlusions of all infrapopliteal arteries. All 10 patients were available for clinical follow-up, and follow-up angiograms were available for eight patients (80%). Clinical failure was defined as recurrence of the clinical signs or symptoms for which the LTA was performed. After 6 months of follow-up clinical failures occurred in nine patients (90%). Four patients had no clinical improvement. Five patients had transient clinical improvement after LTA, and all subsequently had early recurrence of symptoms. The average time from LTA to recurrence of symptoms was 1.7 months. Seven patients had subsequent bypasses or amputations an average of 2.2 months after laser angioplasty. The SFA patency rate by life-table analysis was 25% at 6 months. The single patient with clinical success (at 12 months) had no tibial vessel disease evident on his prelaser angiogram, and he underwent a concomitant inflow procedure at the time of his LTA. We believe that the disappointing results in this small series of patients can be attributed to tibial vessel disease that was not addressed by this technique. We anticipate that with improved technology, with smaller, steerable laser probes, we may be able to treat tibial vessel disease and achieve better results. We conclude that LTA, as it exists today, has a very limited role as the sole treatment of patients with limb-threatening ischemia, and this technique should be offered only to those patients who refuse surgery or have a prohibitively high risk for operative treatment.