Angiographic follow-up after laser-assisted balloon angioplasty

The purpose of this study was to obtain angiographic documentation of patency and recurrence rates after laser-assisted balloon angioplasty.

A prospective assessment of laser-assisted balloon angioplasty (LABA) was performed in 35 limbs of 33 patients with femoral popliteal atherosclerotic disease. There were 21 male and 12 female patients with a mean age of 60.6 years. Indications were intermittent claudication in 19, rest pain in nine, and ischemic ulcer/gangrene in seven limbs. There were 23 totally occluded (mean length 6 +/- 3.8 cm) and 12 stenotic arteries. LABA was achieved with a pulsed Nd:YAG laser with 10 to 25 W and a 2.2/3 mm sapphire probe, followed by balloon dilatation in all but four limbs.

Immediate technical success (< or = 50% residual stenosis) was achieved in 27 (77%) of 35 limbs. Mean ankle/brachial index improved from 0.49 to 0.80 (p < 0.05). Major complications included three perforations, three dissections, and two emboli. Two additional limbs required operation at less than 30 days for a 30-day patency rate of 71.4%. Long-term clinical and noninvasive follow-up ranged from 1 to 55 months (mean 17.68 months). Twenty-nine angiograms were obtained from 3 to 49 months after LABA. Nineteen limbs underwent at least one angiogram, seven underwent two, and three limbs underwent three angiograms. Eleven of the 19 limbs showed evidence of restenosis greater than 50%, all within 12 months. The cumulative patency rate was 71.5% at 1 month, 39.7% at 6 months, and 31.3% at 12, 24, and 36 months.

LABA with the Nd:YAG laser has a 30-day success rate of 71.4%. Angiographic follow-up demonstrates a high incidence of restenosis (> 50%), usually within 12 months. Approximately 50% of limbs eventually required reintervention within 1 year. In view of the disappointing early results, the use of LABA must remain strictly investigational.