Laser arterial disobstructive procedures in 148 lower extremities

Abstract

Preoperative arteriographic findings in immediate postoperative results as well as follow-up studies of treatment with argon and YAG lasers have been evaluated in 148 lesions found in 137 patients. Preoperative arteriography revealed a solitary lesion in 42 of 148 legs (28%) examined, and a combined lesion was found in the remaining 106 legs (72%). Incapacitating intermittent claudication, rest pain, tissue loss, or a combination of these was an indication for laser arterial reconstruction. None of the argon laser—treated lesions was treated with balloon dilatation, but since March 1988 all appropriate YAG laser—treated lesions were immediately followed by laser-assisted balloon angioplasty. The lesions in 64 of 89 legs (72%) treated by argon and 42 of 59 (71%) treated by YAG were successfully recanalized. However, successful angioplasty was performed in 44 of 89 (49%) and 34 of 59 (58%) lesions, respectively. The recanalization depended on the type of lesion (tight stenosis vs occlusion) and the length of lesion (localized vs total-length occlusion). However, the success rate of recanalization was almost the same as the success rate when both laser systems were used. Argon laser treatment proved successful in 19 of 20 (95%) segmental occlusions in popliteal arteries, whereas YAG laser treatment proved successful in four of five (80%) short segmental (<15 cm) occlusions of superficial femoral arteries and in 16 of 23 (70%) long segmental (≥15 cm) occlusions of superficial femoral arteries. In 26 of 36 (72%) total-length occlusions of superficial femoral and popliteal arteries, recanalization was not possible (p < 0.001). Hence laser recanalization was not recommended in those cases. Severely calcified lesions are not ablated by presently available laser systems.