Laser Atherectomy for the Treatment of Peripheral Arterial Disease
Alexandros Mallios1, John Blebea2, Bryan Buster2
1Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK; Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
Insights
Laser atherectomy is a safe and effective treatment for peripheral arterial disease, improving limb salvage rates. However, patients with diabetes, dialysis, or critical limb ischemia (CLI) face higher amputation risks and lower chances of clinical benefit.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Peripheral arterial disease (PAD) significantly impacts patient quality of life and limb viability.
- Laser atherectomy offers a minimally invasive approach to treat PAD.
- Evaluating the clinical outcomes of laser atherectomy is crucial for optimizing PAD management.
Purpose of the Study:
- To assess the clinical results of laser atherectomy in patients with peripheral arterial disease.
- To identify factors influencing treatment success and amputation risk.
Main Methods:
- Retrospective analysis of 300 patients treated with laser atherectomy over 7 years.
- Data collected included patient demographics, lesion characteristics, procedural details, and clinical outcomes.
- Statistical analysis, including univariate and multivariate regression, was used to determine predictors of outcomes.
Main Results:
- Technical success rate was 99% with low complication rates.
- 45% of patients achieved significant clinical improvement or resolution of symptoms.
- Major amputation-free survival was 90% at 5 years.
- Diabetes, dialysis, and critical limb ischemia (CLI) were associated with higher amputation risk and poorer clinical improvement.
Conclusions:
- Laser atherectomy is a safe and valuable tool for limb salvage in PAD.
- Diabetic patients have a significantly higher risk of major amputation.
- Patients on dialysis and with CLI are less likely to experience clinical benefit from this procedure.
Background:
The aim of the study was to investigate the clinical results of laser atherectomy in the treatment of peripheral arterial disease.
Methods:
Retrospective analysis of consecutive patients underwent laser atherectomy at a single institution during a 7-year period by vascular surgeons and interventional cardiologists in a tertiary university-affiliated hospital. Clinical data were retrieved from patient charts and hospital electronic medical records along with the associated arteriograms.
Results:
A total of 461 lesions in 343 limbs were treated in 300 patients with a mean age of 70 years. The indication was critical limb ischemia (CLI) with rest pain or tissue loss in 227 (66%) of interventions and claudication in 116 (34%). All procedures included an associated balloon angioplasty, while stenting was performed in 33%. Technical success was achieved in 99% with only 2 (<1%) cases with an acute procedure-related complication requiring surgical intervention. At a mean follow-up of 28 months (range, 1-87 months; median 24 months), 156 patients (45%) became asymptomatic or achieved significant clinical improvement (resolution of tissue loss or rest pain), 60 (17%) remained with CLI, 30 (9%) had a major proximal amputation, and 18 (5%) had a minor amputation. Freedom from major amputation was 90% at 5 years by life-table analysis. Univariate statistical analysis demonstrated the risk of a major amputation to be associated with diabetes, hemodialysis, and tissue loss (P < 0.05 to P < 0.005), while multivariate logistic regression analysis indicated diabetes to be overwhelmingly important (RR: 4.84; 95% confidence interval [CI]: 1.1-21.3; P < 0.05). In a similar manner, multivariate analysis indicated dialysis (RR: 2.46; 95% CI: 1.01-5.98; P < 0.05) and CLI (RR: 2.27; 95% CI: 1.42-3.65; P < 0.01) were associated with higher likelihood for lack of clinical improvement. There was no difference in major amputation rates between surgeons and interventional cardiologists (RR: 1.5; 95% CI: 0.7-2.1; P < 0.1) although it was 3 times more likely for the patients treated by surgeons to suffer from CLI (odds ratio: 3.2; 95% CI: 1.9-5.4; P < 0.0001).
Conclusions:
Laser atherectomy is a safe and useful adjunct in limb salvage. Diabetics have much higher probability of requiring a proximal amputation, while those on dialysis and with CLI are least likely to gain clinical benefit.
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