Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1989;16(3):216–223.

Percutaneous Laser-Assisted Balloon Angioplasty of Lower-Extremity Arterial Disease in a Free-Standing Laboratory

Clinical Experience with 100 Cases

Harry M Thomas Jr 1, Vincent Siragusa 1, John A Bowers 1, Nancy Allen 1, Gwen Gallant 1
PMCID: PMC324885  PMID: 15227210

Abstract

From September 1987 through May 1988, 86 patients (62 men and 24 women) underwent percutaneous laser-assisted balloon angioplasty, and 2 patients (1 man and 1 woman) underwent laser-assisted balloon angioplasty via cutdowns, in our free-standing catheterization laboratory. The patients' ages ranged from 36 to 81 years. One hundred limbs were treated; each had at least 1 total occlusion, and many had multiple significant occlusions (greater than 50%). Vascular access was attained via the common femoral artery in 62 limbs, via the popliteal artery in 34 limbs, and via a posterior tibial artery cutdown in 4 limbs.

In all, 232 lesions were treated either by percutaneous laser-assisted balloon angioplasty (172 lesions) or by balloon angioplasty alone (60 lesions). Technical success was defined as “recanalization and dilation of the occluded arterial segment, resulting in a recognizable improvement in pulse that persisted until hospital discharge.” The technical success/attempt ratios for the 172 laser-assisted treatments were as follows: iliac artery, 11/17 (64.7%); common femoral artery, 8/9 (88.9%); superficial femoral artery, 62/80 (77.5%); popliteal artery, 25/30 (83.3%); peroneal artery, 14/16 (87.5%); anterior tibial artery, 6/7 (85.7%); and posterior tibial artery, 9/13 (69.2%). Technical failure occurred in 25 limbs. Failure was not related to sex, age, approach artery, or diabetes, but it was related to the indication of impending limb loss (p < 0.01), previous vascular surgery (p < 0.01), amputation (p < 0.01), and lesion length of 20 cm or greater.

Clinical success was defined as “clinical improvement in symptoms, with persistence of an improved pulse at follow-up.” Recurrence was observed in 10 limbs. Recurrence was not related to sex, age, approach artery, diabetes, or lesion length, but it was related to the indication of impending limb loss (p < 0.05); to the fact that the patient was a cigarette smoker at the time of the procedure (p < 0.02); and (inversely) to the number of tibial vessels that remained patent post-intervention.

Five patients required emergency surgery after laser-assisted angioplasty, but no limb amputation has been necessary. Minor complications included perforation (16 cases), hematoma formation (6 cases), dissection (3 cases), hemorrhage (1 case), hives (1 case), and fracture of the laser probe (1 case).

We conclude that percutaneous laser-assisted balloon angioplasty can be safely accomplished in a free-standing laboratory and that the procedure is reasonably successful in patients with totally occluded lower-extremity arteries. (Texas Heart Institute Journal 1989;16:216-23)

Keywords: Angioplasty, laser-assisted

Keywords: angioplasty, transluminal

Keywords: argon

Keywords: arterial occlusive diseases

Keywords: blood flow velocity

Keywords: intermittent claudication

Keywords: ischemia, leg

Keywords: lasers

Keywords: peripheral vascular disease

Keywords: regional blood flow

Full text

PDF
216

Images in this article

218Image
on p.218

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cambria R. P., Faust G., Gusberg R., Tilson M. D., Zucker K. A., Modlin I. M. Percutaneous angioplasty for peripheral arterial occlusive disease. Correlates of clinical success. Arch Surg. 1987 Mar;122(3):283–287. doi: 10.1001/archsurg.1987.01400150037006. [DOI] [PubMed] [Google Scholar]
  2. Cumberland D. C., Sanborn T. A., Tayler D. I., Moore D. J., Welsh C. L., Greenfield A. J., Guben J. K., Ryan T. J. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions. Lancet. 1986 Jun 28;1(8496):1457–1459. doi: 10.1016/s0140-6736(86)91498-4. [DOI] [PubMed] [Google Scholar]
  3. Cumberland D. C., Tayler D. I., Procter A. E. Laser-assisted percutaneous angioplasty: initial clinical experience in peripheral arteries. Clin Radiol. 1986 Sep;37(5):423–428. doi: 10.1016/s0009-9260(86)80048-4. [DOI] [PubMed] [Google Scholar]
  4. Fleisher H. L., 3rd, Thompson B. W., McCowan T. C., Ferris E. J., Reifsteck J. E., Barnes R. W. Human percutaneous laser angioplasty. Patient selection criteria and early results. Am J Surg. 1987 Dec;154(6):666–670. doi: 10.1016/0002-9610(87)90240-6. [DOI] [PubMed] [Google Scholar]
  5. Ginsburg R., Wexler L., Mitchell R. S., Profitt D. Percutaneous transluminal laser angioplasty for treatment of peripheral vascular disease. Clinical experience with 16 patients. Radiology. 1985 Sep;156(3):619–624. doi: 10.1148/radiology.156.3.3161118. [DOI] [PubMed] [Google Scholar]
  6. Grüntzig A., Kumpe D. A. Technique of percutaneous transluminal angioplasty with the Grüntzig ballon catheter. AJR Am J Roentgenol. 1979 Apr;132(4):547–552. doi: 10.2214/ajr.132.4.547. [DOI] [PubMed] [Google Scholar]
  7. Howd A., Spencer H., Loose H., Chamberlain J., Proud G. The widening indications for transluminal angioplasty in peripheral vascular disease. Int Angiol. 1986 Oct-Dec;5(4):275–279. [PubMed] [Google Scholar]
  8. Johnston K. W., Rae M., Hogg-Johnston S. A., Colapinto R. F., Walker P. M., Baird R. J., Sniderman K. W., Kalman P. 5-year results of a prospective study of percutaneous transluminal angioplasty. Ann Surg. 1987 Oct;206(4):403–413. doi: 10.1097/00000658-198710000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. McCowan T. C., Ferris E. J., Barnes R. W., Baker M. L. Laser thermal angioplasty for the treatment of obstruction of the distal superficial femoral or popliteal arteries. AJR Am J Roentgenol. 1988 May;150(5):1169–1173. doi: 10.2214/ajr.150.5.1169. [DOI] [PubMed] [Google Scholar]
  10. Rooke T. W., Stanson A. W., Johnson C. M., Sheedy P. F., 2nd, Miller W. E., Hollier L. H., Osmundson P. J. Percutaneous transluminal angioplasty in the lower extremities: a 5-year experience. Mayo Clin Proc. 1987 Feb;62(2):85–91. doi: 10.1016/s0025-6196(12)61875-8. [DOI] [PubMed] [Google Scholar]
  11. Sanborn T. A., Cumberland D. C., Greenfield A. J., Welsh C. L., Guben J. K. Percutaneous laser thermal angioplasty: initial results and 1-year follow-up in 129 femoropopliteal lesions. Radiology. 1988 Jul;168(1):121–125. doi: 10.1148/radiology.168.1.2967985. [DOI] [PubMed] [Google Scholar]
  12. Sanborn T. A., Faxon D. P., Haudenschild C. C., Ryan T. J. Experimental angioplasty: circumferential distribution of laser thermal energy with a laser probe. J Am Coll Cardiol. 1985 Apr;5(4):934–938. doi: 10.1016/s0735-1097(85)80436-8. [DOI] [PubMed] [Google Scholar]
  13. Sanborn T. A., Greenfield A. J., Guben J. K., Menzoian J. O., LoGerfo F. W. Human percutaneous and intraoperative laser thermal angioplasty: initial clinical results as an adjunct to balloon angioplasty. J Vasc Surg. 1987 Jan;5(1):83–90. [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES