Laser Assisted Angioplasty in Peripheral Arterial Disease

Abstract

Since the popularity of percutaneous trans luminal balloon dilatation [BD) for peripheral arterial lesions, physicians have concentrated on helping develop newer generation of catheter related devices that would extend our ability to reopen or recanalize stenosed or obstructed arteries.

The potential for the use of laser energy on cardiovascular tissues has been demonstrated by many animal and human studies ( 1). These. Applications’ include angioplasty, endarterectomy, repair of aneurysms and arterial dissections, excision of venous valves, sealing of arterial and ‘venous anastomoses, transmyocardial neovascularization, valvuloplasty, ablation of abnormal conduction pathways and myectomy or endocardiectomy.

All patients are examined in the office every’ three months, and have doppler studies at three, six and twelve months. Outpatient arteriography is performed at six and twelve months after LAR. Our LAR program began in September 1987 and to date we have used it in 24 patients. To put it into proper perspective, we have seen approximately 2500 patients referred for peripheral arterial disease, of whom about 500 have undergone reconstructive arterial surgery and another 40 BD alone. The limited number of patients subjected to any invasive procedure reflects our generally conservative treatment of stable and non-progressive arterial disease.

Exciting new developments in LAR include radiofrequency lasers, the excimer laser and the concept of a ‘smart’ laser. The ‘smart’ laser is a computer based system with the ability to discriminate plaque from healthy tissue. To address the risk of thrombosis following BD or LAR, intraluminal stents are being placed to expand the arterial lumen.