PS128. Outcomes of Excimer Laser Atherectomy for the Treatment of Infrainguinal Occlusive Disease in Patients With Critical Limb Ischemia

Abstract

To evaluate outcomes of patients undergoing Excimer Laser atherectomy (ELA) for the treatment of infrainguinal occlusive disease in patients with critical limb ischemia. A retrospective review of all patients who underwent infrainguinal ELA for critical limb ischemia at Dartmouth-Hitchcock Medical Center from November 2005 to December of 2008 was performed. The primary outcome measure was limb salvage. Secondary outcomes included amputation free survival and freedom from reintervention. Data were analyzed using life table analysis. Fifty-two procedures were performed. The average patient age was 76 years, 73% had tissue loss. Fifty five percent had undergone prior interventions. The superficial femoral artery was treated in 47% of cases, the popliteal artery in 25% and the tibial arteries in 28%. Sixty-five percent of treated lesions were occlusions; with 41 percent of lesions being TASC C and 43 percent TASC D lesions. Median follow-up was 14-months (range 2-days to 43-months). Overall technical success was achieved in 92%. Transluminal angioplasty or stent deployment was required for residual stenosis or dissection following ELA in 85% percent of cases. Technical complications occurred in 10 patients (19%). Distal embolization occurred in 2 cases, arterial perforation in 3 cases and dissection in 5 cases. Ipsilateral limb salvage was 75% at one year and amputation free survival rate was 65%. Freedom from reintervention was 54% at one year, and 10 (20%) patients went on to require lower extremity bypass. ELA can be used safely with a high degree of success for treatment of multilevel infrainguinal arterial disease, though it is not sufficient as stand alone therapy. While reasonable limb salvage rates can be achieved, long-term patency is difficult to maintain and warrants careful follow-up.