Percutaneous laser-assisted balloon angioplasty of lower-extremity arterial disease in a free-standing laboratory: clinical experience with 100 cases.

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.