Initial results of laser recanalization in lower extremity arterial reconstruction.

One hundred ninety-five patients have been evaluated for possible laser recanalization (LR). Current laser delivery systems are most appropriate for the treatment of superficial femoral, popliteal, or isolated common iliac artery occlusions, and therefore one half (110) of the patients were initially excluded because of inappropriate disease location. An additional 39 patients were excluded because they showed minimal symptoms or the procedure would have been excessively risky for them. The remaining 46 patients underwent LR for total arterial occlusions, with relief of symptoms and increased ankle brachial indexes in 22 (48%). Of the four patients who could not be surgically reconstructed because of tibial artery occlusion, none was successfully treated. Only one patient required emergency reconstruction for ischemia after LR failure, and no procedures were required for treatment of perforation or bleeding. Successful LR was most likely when isolated lesions less than 15 cm in length, in the common iliac, middle or distal superficial femoral, and above-knee popliteal arteries were treated. Of the 22 patients for whom LR was successful, 11 would have been candidates for standard surgical therapy, six would have been excluded from such therapy by medical or surgical risks, and five had symptoms usually considered too mild to be offered surgery. Thus, at present the impact of LR on the treatment of patients with peripheral vascular disease appears limited.