Percutaneous Peripheral Revascularisation with Excimer Laser: Equipment, Technique and Results

Abstract

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.

An Update on Endovascular Therapy of the Lower Extremities

“…[42][43][44][45][46] The experience with laser intervention in the late 1980s was somewhat disappointing in terms of durability, but this was related to the type of lasers utilized and associated thermal injury. [42][43][44] Recent advances in catheter design and technique, including saline infusion, have minimized the thermal energy associated with laser therapy and reduced the risk of vessel dissection. The results of the Laser Atherectomy for Critical Ischemia (LACI-1) pilot study are promising for patients with nonhealing wounds.…”

“…Debulking the SFA or popliteal artery utilizing laser technology has also helped to improve outcomes and durability for femoro-popliteal disease. [42][43][44][45][46] The experience with laser intervention in the late 1980s was somewhat disappointing in terms of durability, but this was related to the type of lasers utilized and associated thermal injury. [42][43][44] Recent advances in catheter design and technique, including saline infusion, have minimized the thermal energy associated with laser therapy and reduced the risk of vessel dissection.…”

Current state of endovascular treatment of femoro-popliteal artery disease

“…[72][73][74][75] Recent advances in catheter design and technique, including saline infusion, have minimized the thermal energy associated with laser therapy and reduced the risk of vessel dissection. The results of the Laser Atherectomy for Critical Ischemia (LACI-2) pilot study are promising for patients with non-healing wounds.…”

Rescue excimer laser angioplasty for treatment of critical limb ischemia

“…Treating percutaneously CLI can improve symptoms, save limbs, or, at least, provide acceptable vascular bed for open surgical revascularization. With that in mind, the outcomes of excimer laser angioplasty in CLI as reported by Boccalandro et al [1] and others as well [3, 4] are realistic and encouraging. Specifically, Boccalandro et al [1] reported an 84% procedural success, 88% limb salvage when laser recanalization was combined with surgical revascularization, and 72% actual freedom from surgical revascularization or limb loss was achieved.…”