Laser angioplasty of peripheral arteries after unsuccessful recanalization of the superficial femoral artery

Abstract

AIM: To demonstrate the range of applying laser angioplasty after unsuccessful recanalization of the superficial femoral artery (SFA) with conventional interventional techniques. MATERIALS AND METHODS: In a prospective trial in 94 cases with occlusion of the SFA and formerly unsuccessful conventional percutaneous transluminal angioplasty, laser angioplasty for recanalization was applied. The average occlusion length of the SFA was 17.5 cm (range 4-36 cm). The recanalization attempt was made using the crossover technique in 78 patients, in eight patients with the antegrade technique and in another eight patients using the transpopliteal technique. The primary recanalization attempt was performed with Terumo wires (curved and straight) as well as different catheters (Multipurpose/Vertebralis/Cobra). After the unsuccessful recanalization attempt the laser catheter was applied. RESULTS: The application of laser angioplasty demonstrated a successful recanalization of the SFA in 76/94 patients (80.9%). In 18 patients (19.1%) the recanalization was not possible even with percutaneous transluminal laser angioplasty (PTLA). The reason for the unsuccessful PTLA was in 10 cases due to obstructing calcified material, which was resistant to PTLA application. In four cases obstructing calcifications caused the laser catheter to be positioned in subintimal tissue, resulting in perforation of the SFA. In another four patients there was an aberrant anatomy of the SFA which resulted in a direct vessel injury after advancing the laser catheter. After a follow-up period of 12 months primary, primary-assisted and secondary patency rates were 50.0%, 65.8% and 73.7%, respectively. DISCUSSION: In primarily unsuccessful recanalization of the SFA, PTLA allows in 80% of cases a successful recanalization of the SFA. The technical success rate and the patency rate support the application of PTLA.

Treatment of long superficial femoral artery occlusions with excimer laser angioplasty: long‐term results after 48 months

“…Many patients required reinterventions (74.0%) but the number of complications was low. These results are comparable to other results evaluating PTLA with high technical success rates and good long-term patency rates, but repeat interventions were necessary, too (21)(22)(23).…”

“…Laser angioplasty has its advantages in the treatment of long and highly calcified occlusions or occlusions, which has a failed recanalization attempt by PTA (22,23).…”

Chronic total occlusions in the superficial femoral artery: A novel strategy using a 1.5 mm J‐tip hydrophilic guidewire with an over‐the‐wire balloon catheter under ultrasound guidance

“…The conventional guidewire may often take a path close to the vessel wall instead of the more central part of the lumen. Despite the advent of new devices and techniques such as subintimal angioplasty [4], laser angioplasty [5], blunt dissection devices [6], and optical coherence reflectometry [7], none of these have been shown significantly to improve the success rates for intervention in CTOs. These techniques do not allow identification of guidewire and balloon position or direction during the procedure.…”

Behandlung von Instent-Reokklusionen der femoropoplitealen Arterien mit einem mechanischen Rotationskatheter

“…Es gibt verschiedene ablative Verfahren, wie z. B. die Laserangioplastie [10,11], der Silverhawk-Atherektomiekatheter (Fox Hollow, Redwood, USA) [12,13] sowie das Pathway-Atherektomiesystem [14,15], welche zur Behandlung von Instent-Läsionen geeignet sind. Ziel dieser prospektiven Single-Center-Studie ist es, einen Rotationskatheter, der in verschiedenen Untersuchungen seine Wirksamkeit bei akuten und subakuten Verschlüssen bewiesen hat und für den zumindest teilweise Abtragung der zugrunde liegenden Stenosierung [16 -18] berichtet wird, hinsichtlich der Sicherheit und Effektivität bei der Behandlung von subakuten und chronischen Instent-Reokklusionen der femoropoplitealen Arterien zu untersuchen.…”