Nd:YAG laser with sapphire tip combined with balloon angioplasty in peripheral arterial occlusions: Long-term results

Abstract

In 167 patients with complete occlusion (>3 cm) of the femoropopliteal artery, percutaneous transluminal laser angioplasty (PTLA) was performed after an unsuccessful attempt at crossing with a guide wire and was immediately followed by balloon dilatation. An Nd-YAG laser and an optical fiber delivery system with a sapphire tip serving as a contact probe were used for PTLA. In 132 of 167 (79%) patients, the occluded segment was successfully reopened. Clinical symptoms improved in 126 of 167 (75%) patients. PTLA was unsuccessful in 35 patients, and in 15 of these, injury of the vessel wall occurred. In one patient, surgical drainage of a large hematoma became necessary. All patients in whom recanalization had been achieved were randomized to receive long-term treatment with either phenprocumarol or acetylsalicylic acid (ASA) plus dipyridamole to prevent rethrombosis. At 36 months of follow-up, the cumulative patency rate (CPR) was 63%. A complete reobstruction in 32 patients (24%) and a partial reobstruction in 15 patients (11%) were found angiographically. The CPR after 36 months was significantly lower (p<0.05) in patients younger than 60 years of age (54%) than in patients older than 60 (68%); it was also significantly lower (p<0.05) in patients with reduced peripheral runoff (55%) due to obstructed arteries of the lower leg than in patients with unaffected runoff (73%). The CPR was 65% in recanalized segments shorter than 7 cm and was 62% in recanalized segments longer than 7 cm. In patients treated with ASA plus dipyridamole, the CPR was 60%, and in patients who underwent anticoagulation therapy, the CPR was 65% (NS). The CPR was also significantly lower (p<0.05) in patients who were still smoking during follow-up (62%) than in patients who never smoked or quit smoking (77%). These results suggest that PTLA combined with balloon dilatation is beneficial for the management of patients with chronic peripheral arterial occlusion and provides good long-term patency rates.