Percutaneous peripheral revascularisation with excimer laser: equipment, technique and results

Laser angioplasty has been evaluated for coronary applications since the early 1980s. Early complications of dissection, perforation and thermal injury led to a loss of enthusiasm for this technique. Recent advances in catheter development, including optimally spaced laser fibres, athermic 308 nm wave-length catheters, and saline infusion techniques have produced larger laser channels, minimised thermal injury and significantly reduced vessel dissection. This improvement in equipment and technique has led to the growing use of lasers in the field of percutaneous treatment of peripheral vascular interventions. Convincing data supporting laser use in thrombus may lead to widespread use of laser in diffuse, thrombotic, long occlusions in the SFA (superficial femoral artery) and for infrapopliteal disease treatment in patients with non-healing ulcers. Little literature exists on the specific results of 308 nm Excimer laser catheter use for peripheral angioplasty. Significant research is still needed to prove the role of debulking in peripheral applications, but upcoming clinical trial data from the PELA (peripheral angioplasty vs. laser study in long SFA occlusions) and LACI (laser angioplasty in chronic ishaemia) may help to solve these questions in the near future. This article attempts to outline the technical issues of laser catheter use in percutaneous peripheral interventions, including access, sheath selection and wire techniques to cross even the most challenging obstructions in the peripheral circulation.