Laser-assisted reconstructive vascular surgery.

Abstract

To clarify the efficacy of laser-assisted reconstructive vascular surgery (LARVS) for patients with severe symptoms of peripheral arterial occlusive disease, 118 ischemic legs of 104 patients were retrospectively analyzed (argon:89 and YAG:29 lasers). Of those 118 legs, 26 (22%) had tissue loss, 60 (51%) had rest pain, and 32 (27%) had incapacitating intermittent claudication. The LARVS was adequate in 60 of 118 (51%) and inadequate in 58 of 118 (49%). With argon:89 and Nd:YAG:29 lasers, respectively, 41 of 89 (46%) and 19 of 29 (66%) were adequate. In the superficial femoral artery (SFA) and popliteal artery (PA), the LARVS was adequate in 31 of 43 (72%) in segmental occlusion and in one of 31 (3%) in total-length occlusion (p less than 0.001). In segmental occlusion of the SFA, however, argon:89 and Nd:YAG:29 lasers were adequate in four of 12 (33%) and in 10 of 12 (83%), respectively (p less than 0.05). The legs in which laser was used in more than one artery (eight of eight) or in occluded grafts (proximal SFA to distal PA; three of 18) required amputation within 30 days. A follow-up study demonstrated patency in 31 of 34 (91%) 1-24 months later with the argon:89 laser and in 15 of 16 (94%) 1-6 months later with the Nd:YAG:29 laser. This study indicates that LARVS was adequate in segmental occlusions, particularly in SFA and PA lesions; however, total-length occlusions and combination arterial lesions were not appropriate for the currently available laser systems. Laser application should not be performed if a guidewire passes through the lesion, since these lesions may be more appropriately treated with balloon angioplasty.