2007 Abstracts: Mid-Term Results with Laser Atherectomy in the Treatment of Infrainguinal Occlusive Disease

Background: Laser atherectomy (LA) offers a potential intervention for multivessel infrainguinal disease in patients with poor revascularization options. Despite promising early results reported in the literature, skepticism exists to the benefit and place of LA in peripheral vascular disease.
Methods: From July 2004 to June 2006 patients undergoing LA were retrospectively reviewed. Clinical, demographic, surgical and follow-up variables potentially associated with the endpoints of technical success, non-definitive therapy, and limb salvage was assessed.
Results: Over the study period, 40 patients underwent LA with an average follow up of 461 ± 49 days (range 17-1050 days). Twenty-one patients were female and nineteen were male, with an average age of 68 ± 2 years (range 43-93 years). The indication for LA was critical limb ischemia in twenty-seven (67.5%) and for lower limb claudication in 13 (32.5%). A total of 64 lesions were treated in the following arterial segments: 26 femoral, 21 popliteal, 17 and tibial. The arterial segments were distributed by the Transatlantic Inter-Society Consensus (TASC) classification as follows: Femoral-Popliteal; A (n=3), B (n=16) C (n=9), D (n=5) and Infrapopliteal lesions; A (n=1), B (n=3), C (n=3), D (n=5). The overall technical success rate was 87.5%. LA was the definitive therapy for 23 patients (57.5%), with average clinical revascularization time of 182 ± 43 days. The remaining patients (n=17), Twelve (30%) underwent subsequent revascularization, and 7 (17.5%) required eventual amputation. LA delayed later operation by a mean of 47.7 ± 13 days. Chronic renal failure is a risk factor for amputation (p<0.001) and re-operation (p=0.05) while Type 2 Diabetes Mellitus is risk factor amputation (p=0.04).
Conclusion: This data demonstrates that LA can be employed as a temporizing revascularization method with a high initial technical success rate. Chronic renal failure and diabetes are risk factors for a negative outcome. Poor results in patients with diabetes and renal failure necessitate careful case selection in this subgroup, in whom LA is less likely to provide either a definitive result or limb salvage.