Laser thermal angioplasty for the treatment of obstruction of the distal superficial femoral or popliteal arteries

The success rates and clinical effectiveness of percutaneous laser thermal angioplasty for obstruction of the distal superficial femoral or popliteal arteries were assessed. Laser thermal angioplasty was performed with the first commercially available laser system on 25 atherosclerotic vascular lesions in 20 lower extremities of 18 patients. Fifteen of the lesions were occlusions (average length, 5.6 +/- 3.1 cm), and 10 were high-grade stenoses (average length, 2.6 +/- 1.8 cm). Indication for angioplasty was claudication limiting life-style in 12 extremities and threatened limb loss in eight. All patients were treated with a 1.5- or 2.0-mm metal-capped optical fiber attached to a 14-W argon-ion laser. Balloon angioplasty was performed after laser recanalization in all successful cases. The patients were followed by Doppler ankle/brachial index and clinical evaluation. Laser thermal angioplasty was technically successful (vessel recanalization) in 18 (90%) of 20 of the cases. Fourteen (70%) of 20 extremities were successes by ankle/brachial index follow-up, while 15 (75%) of 20 remained clinically improved after an average follow-up of 7.8 +/- 5.3 months. Laser thermal angioplasty has a technical and clinical success rate that compares favorably with previous reports of balloon angioplasty. With proper patient selection, laser thermal angioplasty can reduce the difficulty of traversing lesions that are amenable to standard balloon angioplasty and increase the number of vascular lesions that can be treated percutaneously but could not be recanalized without the use of laser energy.