Limitations and pitfalls of laser angioplasty

Overall, the initial and long-term results of LABA have been disappointing. Poor initial recanalization rates and high restenosis and hemodynamic failure rates have caused investigators to reevaluate the indications for LABA. This reevaluation has resulted in an appropriate limitation of the indications for LABA. At present, LABA is probably indicated only for the treatment of patients with symptomatic, isolated arterial occlusions in whom conventional balloon angioplasty cannot be done because mechanical recanalization using a guidewire is not possible. Other uses of LABA in patients with peripheral vascular disease are discouraged and should be considered experimental. New innovations in technology, including improved arterial imaging techniques and better laser delivery systems, are required before LABA can become a standard therapy for the treatment of patients with peripheral vascular disease. A search for an "ideal" laser wavelength for arterial recanalization is futile until these developments occur. Once these innovations are in use, laser angioplasty may be an important technique in the treatment of peripheral vascular disease. This potentially valuable tool for the vascular surgeon should not be abandoned. Rather, it should be laid aside until it is better developed.