Salvage of an ischemic limb by laser angioplasty: Description of a New Technique

Ginsburg, Robert N.; Kim, D.‐S.; Guthaner, Diana F.; Tóth, J; Mitchell, R. Scott

doi:10.1002/clc.4960070112

Cited by 123 publications

(15 citation statements)

References 9 publications

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“…We have been able to demonstrate fibrosis and moderate calcification [7] in our models, but we have not been able to approach the severe calcification often seen in human arteriosclerosis. Since no ideal animal model exists, early clinical trials of the laser have been proposed [6,9]. We have shown that a standard surgical procedure, open endarterectomy, can be performed with the laser.…”

Section: Discussionmentioning

confidence: 99%

Experimental arteriosclerosis treated by conventional and laser endarterectomy

Eugene

McColgan

Pollock

et al. 1985

Journal of Surgical Research

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Open laser endarterectomy was compared to standard surgical endarterectomy in the rabbit arteriosclerosis model. The aorta was exposed by a thoracoabdominal exploration in 16 rabbits. In Group I (8 rabbits), a conventional endarterectomy (CE) was performed with standard vascular instruments. In Group II (8 rabbits), laser endartercctomy (LE) was performed with an argon ion laser (488 nm and 514.5 nm) at a power of 1.0 W. Aortas were fixed, serially sectioned (6 pm) and stained (H + E) following each procedure. Gross and light microscopic examination revealed identical results for the endarterectomy surfaces of CE and LE. The proper cleavage plane within the media was developed with both techniques and the remaining arterial wall was not damaged with either procedure. The end points of LE were consistently superior to those of CE because of phototherapy fusion. The LE end points were tapered and the intima was fused. Intimal flaps were seen in 2/8 CE experiments and the remaining end points exhibited an uneven transition. LE required an average energy density of 124 + 9 J/cm*. We conclude that LE provides a satisfactory method for the in vivo evaluation of laser radiation upon arteriosclerotic arteries. LE may be the way to begin clinical laser trials. o 1985 Academic Press Inc.

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Section: Discussionmentioning

confidence: 99%

Experimental arteriosclerosis treated by conventional and laser endarterectomy

Eugene

McColgan

Pollock

et al. 1985

Journal of Surgical Research

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“…Similarly, it was stated following presentation at the IX European Congress of Cardiology meeting in July 1984 that three of three human femoral arteries recanalized with laser energy reoccluded [16]. Ginsburg et al [8] reported that a patient undergoing laser recanalization of a totally occluded superficial femoral artery and a 95% stenotic deep femoral artery had only leg fatigue after walking 2-3 blocks, and no nocturnal or rest pain 6 months after the recanalization procedure, but no data on follow-up arteriograms have been reported. The patient was maintained on aspirin (325 mg/day) after recanalization.…”

Section: Discussionmentioning

confidence: 99%

Complete patency in thrombus‐occluded arteries two weeks after laser recanalization

et al. 1985

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The potential problem of rethrombosis after laser recanalization was studied in 16 thrombus-occluded canine femoral arteries. Balloon de-endothelialization and thrombin-human blood injection produced adherent, completely occlusive thrombi 4.13 +/- 1.54 cm in length; laser exposure of the thrombi occurred at 18.35 +/- 22.1 hours. The argon laser catheter was introduced via a proximal arteriotomy and a power of 3.83 +/- 0.58 W delivered for 411.3 +/- 296.87 seconds. Follow-up period was 14 days. All arteries were patent immediately after and 14 days following lasing, as demonstrated by angiography. There was no vessel perforation. Seven of the dogs were maintained on aspirin and dipyridamole 4 days before and throughout the study, but there were no differences in thrombus length, laser power, or duration of laser exposure between these dogs and those receiving no anti-platelet therapy. Control thrombosed arteries (without laser energy application) showed no autolysis within 14 days in all dogs and up to 95 days in three dogs followed for this period of time. These data show that rethrombosis of totally occluded, thrombosed arteries is not present up to 2 weeks later after laser recanalization, with or without the aid of anti-platelet therapy.

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“…A variety of catheter systems have been developed for the transluminal ablation of atherosclerotic obstructions [Choy et al, 1982;Lee et al, 1983a;Geschwind et al, 1984;Ginsburg et al, 1984;Abela et al, 19851. So far, however, the intravascular application of laser light has been limited because of a high complication rate.…”

Section: Introductionmentioning

confidence: 99%

Effects of varying argon ion laser intensity and exposure time on the ablation of atherosclerotic plaque

Strikwerda¹,

Bott‐Silverman²,

Ratliff³

et al. 1988

Lasers Surg Med

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Using continuous wave (CW) argon ion laser light, a total of 253 laser exposures of varying power (1.5, 3, 5, 8 or 10 W) and duration (20-1,333 ms) were delivered to four segments of human atheromatous aorta obtained at autopsy. Exposure conditions were controlled by using an optically shielded laser catheter that provided a 500 micron spot of light of known power. Two thresholds for consistently reproducible ablation could be defined-an intensity threshold at 25.5 W/mm2 and a fluence threshold at 3.2 J/mm2. Above threshold, a fluence of 5.1 J/mm2 was found to produce the most efficient ablation, ie, removed the greatest volume (mm3) per energy delivered (J) compared to other fluence levels employed (p less than 0.0001). Between aortic segments, however, considerable variability in efficiency (mm3/J) was observed, possibly owing to different optical properties and/or plaque composition. Low-intensity laser radiation produced inconsistent ablation and extensive coagulation effects to surrounding tissue. When a fluence of 5.1 J/mm2 was constructed with a high-intensity laser beam and a short exposure time, consistent and efficient tissue removal resulted without histologic evidence of coagulation necrosis.

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Salvage of an ischemic limb by laser angioplasty: Description of a New Technique

Cited by 123 publications

References 9 publications

Experimental arteriosclerosis treated by conventional and laser endarterectomy

Experimental arteriosclerosis treated by conventional and laser endarterectomy

Complete patency in thrombus‐occluded arteries two weeks after laser recanalization

Effects of varying argon ion laser intensity and exposure time on the ablation of atherosclerotic plaque

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