Excimer laser-assisted recanalization of long, chronic superficial femoral artery occlusions
D Scheinert1, J R Laird, M Schröder
1Department of Medicine II, University of Erlangen-Nürnberg, Erlangen, Germany. dierk.scheinert@gmx.de
Insights
Excimer laser-assisted angioplasty (ELA) safely recanalizes superficial femoral artery (SFA) occlusions. Long-term success requires diligent monitoring and timely re-interventions for sustained patency and improved quality of life.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Superficial femoral artery (SFA) occlusions significantly impair lower limb circulation, leading to claudication and critical limb ischemia.
- Traditional treatment options for long SFA occlusions have limitations in efficacy and invasiveness.
Purpose of the Study:
- To evaluate the safety and effectiveness of excimer laser-assisted angioplasty (ELA) for recanalizing chronic SFA occlusions.
- To assess the technical success rates, complication profiles, and patency outcomes of ELA in a large patient cohort.
Main Methods:
- Retrospective analysis of 318 patients undergoing ELA for 411 SFA occlusions (average length 19.4 cm).
- Patients presented with severe claudication (75%) or critical limb ischemia (21%).
- Initial and secondary crossing success rates, procedural complications, and ankle-brachial index (ABI) changes were recorded.
Main Results:
- Technical success rate for ELA recanalization was 90.5% after secondary attempts.
- Complications included acute reocclusion (1.0%), perforation (2.2%), and distal embolization (3.9%).
- One-year primary patency was 33.6%, with assisted primary and secondary patency rates of 65.1% and 75.9%, respectively.
Conclusions:
- Excimer laser-assisted angioplasty is a safe and effective method for recanalizing long SFA occlusions.
- Maintaining long-term patency and improving quality of life necessitate intensive surveillance and prompt repeat interventions.
Purpose:
To examine the safety and efficacy of excimer laser-assisted angioplasty (ELA) for recanalization of superficial femoral artery (SFA) occlusions.
Methods:
Data were analyzed from 318 consecutive patients (207 men; mean age 64.2 +/- 10.7 years, range 33-91) who underwent ELA of 411 SFAs with chronic occlusions averaging 19.4 +/- 6.0 cm in length. More than 75% of patients had severe claudication (category 3). Critical lower limb ischemia with rest pain or minor tissue loss was present in 6 and 15 patients, respectively. The mean ankle brachial index (ABI) before and after exercise was 0.62 +/- 0.15 and 0.40 +/- 0.18, respectively.
Results:
The initial attempt (crossover approach 89.7%, antegrade 6.6%, transpopliteal 3.6%) to cross the occlusion with an excimer laser catheter was successful in 342 (83.2%) of 411 limbs. A secondary attempt performed in 44 of 69 failed cases was successful in 30 limbs, increasing the technical success rate to 90.5% (372/411). Complications included acute reocclusion (4, 1.0%), perforation (9, 2.2%), and distal thrombosis/embolization (16, 3.9%). Postprocedurally, 219 (68.8%) patients were asymptomatic; mild (category 1) or moderate (category 2) claudication remained in 53 (16.6%) and 26 (8.2%) patients, respectively. The primary patency at 1 year was 33.6%. In the majority of patients, reocclusion was treatable on an outpatient basis. The 1-year assisted primary and secondary patency rates were 65.1% and 75.9%, respectively.
Conclusions:
Long SFA occlusions can be recanalized safely and successfully by ELA. However, to maintain patency and quality of life, intensive surveillance using objective testing followed by prompt repeat intervention are mandatory.
