Femoropopliteal artery recanalization: factors affecting clinical outcome of conventional and laser-assisted balloon angioplasty.

PURPOSE: The clinical efficacy of 44 successful conventional and laser-assisted recanalizations of the femoropopliteal artery was assessed in a noncomparative study by the life-table method. METHODS: Laser-assisted angioplasty using continuous laser and a sapphire probe was performed to achieve primary recanalization in femoral artery occlusions when conventional guidewire recanalization had already failed. Nineteen of the patients underwent a conventional recanalization (PTA; mean length of occlusion 4.4 +/- 4.1 cm), and 25 underwent percutaneous laser-assisted angioplasty (PLA; mean length of occlusion 10.1 +/- 6.7 cm). RESULTS: There was no statistical relation between the preprocedure Fontaine classification and the success rate in the PTA cases (p = 0.25), whereas there was a statistical relation in the PLA cases: The success rate in patients preprocedurally classified as Fontaine II was better than in those classified as Fontaine III/IV (p = 0.05). After a 3-year follow-up the patency rate in the patients with the PTA recanalizations was 37% and that in those with the PLA procedure was 53%. This difference was not statistically significant (p = 0.47). CONCLUSION: It is concluded that the laser should remain an investigational device.

Femoropopliteal arterial occlusions: laser-assisted versus conventional percutaneous transluminal angioplasty.

Recanalization of 75 femoropopliteal arterial occlusions was attempted with either conventional percutaneous transluminal angioplasty (n = 28; mean occlusion length, 5.5 cm) or percutaneous laser-assisted angioplasty (PLA) (n = 47; mean occlusion length, 11.6 cm). Conventional recanalization was technically successful in 21 patients (mean occlusion length, 4.4 cm +/- 3.9) and was a technical failure in seven (mean occlusion length, 8.7 cm +/- 6.2). The technical outcome was a function of the length of the occlusion (P = .04). The PLA procedure, performed with a laser with a sapphire probe, was a technical success in 32 patients (mean length, 10.7 cm +/- 6.5) and a technical failure in 15 (mean length, 13.6 cm +/- 8.2). With PLA, the length of the occlusion did not determine the technical (P = .20) or clinical (P = .12) outcome. In patients with gangrene, PLA of occlusions longer than 5 cm failed clinically (P = .02). This PLA method appeared to be safe and allowed passage through occlusions longer than 10 cm.