Initial Results of Laser Angioplasty under Angioscopic Guidance for Salvage of an Ischemic Lower Limb: Preliminary Report

From March to July 1989, nine patients at risk for peripheral artery disease underwent intraoperative Nd: YAG laser angioplasty using angioscopy at the Veterans General Hospital (Taipei, Taiwan, Republic of China). Following the laser angioplasty, balloon dilatation was performed in all cases. Eight men and one woman at an average age of 68 were included in the study (range: 58 to 78 years old).

Ischemic symptoms included five patients with disabling claudication, four with pain at rest and one with gangrene on the toes. Eight of the nine patients had complete occlusions ranging from 2 to 19 cm in length. Two patients had high degree multiple segmental stenosis of the superficial femoral artery from 1 to 2 cm in length.

Initial clinical success (indicated by relief of symptoms and increase in Doppler ankle pressure and index) and improvement in the angiographie luminal diameter was noted in 9 of 10 occluded vessels (90%) that underwent Nd:YAG laser treatment which was delivered at 10 to 12 watts through laser probes. Prelaser intraluminal diameter increased from 0.05 ± 0.07 to 0.53 ± 0.07 mm, Doppler ankle pressure index rose from 0.51 ± 0.12 to 0.81 ± 0.12, Doppler ankle pressure increased from 62.44 ± 16.10 to 104 ± 21.21 mmHg and the amplitude of pulse volume recorder at ankle level rose from 5.77 ± 2.80 to 12.11 ± 2.77 mm as compared with prelaser therapy (P < 0.05). Laser angioplasty failed in one patient who developed a 15 cm total occlusion of the superficial femoral artery and poor distal runoff due to severe calcification. Angioscopy was a successful visual guide in 100% of the 9 patients. No complications occurred.

Intraoperative laser angioplasty together with angioscopic assistance provided a safe and effective therapeutic tool in the treatment of arterial occlusive disease. This technique has the potential to increase the initial success rate of angioplasty for lesions that are difficult or impossible to treat by conventional means. Initial intraluminal anatomic and functional hemodynamic improvement was documented in the successful cases; long-term follow-up will be necessary for further evaluation of the technique.

Transluminal balloon angioplasty provides an alternative treatment to vascular reconstructive surgery in peripheral atherosclerotic arterial occlusive disease.^'2 Balloon angioplasty has been successful in dilating stenosis lesions in patients with femoropopliteal disease. The procedure is very difficult and appears to be ineffective in patients with total occlusion.³

Recent developments of medical lasers which can be transmitted fiberoptically to a metallic tip, have demonstrated the potential to recanalize obstructive atherosclerotic arteries and serve as an adjunct or alternative to conventional transluminal balloon angioplasty or bypass surgery.^3-7 The aim of the present study is to evaluate the efficacy of transluminal laser angioplasty under angioscopic assistance for the treatment of occlusive arterial disease during a concomitant vascular reconstruction.