Technical considerations and factors that influence the outcome of laser-assisted angioplasty

In the last several years many studies have been conducted to evaluate the feasibility of laser-assisted angioplasty procedures as a therapeutic option for the treatment of patients with peripheral vascular disease. Assessing patient outcomes from studies done at various centers is complicated by the number of variables in patient selection, technical aspects of the procedures, laser parameters, and followup procedures. An ongoing process of defining and refining important parameters and aspects of these procedures is evolving. Important components in achieving good long-term results are technical dexterity with catheter systems, knowledge of angiography techniques, in-depth knowledge in the evaluation and treatment of patients with peripheral vascular disease, and a thorough understanding of laser biophysics and tissue interactions. The importance of technical details as a determinant of successful outcome in the treatment of these patients is discussed. Percutaneous vascular access is the method of choice for angioplasty procedures, but about 36% of patients will require surgical exposure of the femoral artery and possibly endarterectomy of patchplasty. In 11% of patients, the intraluminal channel is inadequate, revascularization is incomplete, or for other technical reasons surgical bypass is necessary. Peripheral laser-assisted angioplasty is a viable treatment alternative in selected patients. As the technique matures the value of its role in the therapeutic armamentarium will emerge.