The Flemish Experience with Excimer Laser-assisted Angioplasty for Severe Critical Limb Ischaemia in Infrapopliteal Lesions

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Abstract

The recently published Laser Assisted Angioplasty for Critical Limb Ischemia (LACI)-Belgium study1 included a total of 48 patients with critical limb ischaemia (CLI) treated between 7 January and 6 June 2003. All patients had at least one angiographically identifiable infrageniculate target artery and were poor surgical candidates. Treatment consisted of excimer laser angioplasty (ELA) in conjunction of percutaneous transluminal angioplasty (PTA) with optional stenting.
A limb salvage rate of 90.5% after six months was demonstrated in this severely diseased patient population. This result equals and confirms the outcome of the previously conducted LACI phase 2 Trial2, which reported on a similar patient population.

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A closer analysis of the subgroup of patients in the LACI-Belgium study with infrapopliteal lesion involvement was performed and the data on this limited patient (n=31) cohort seemed promising. The reported limb salvage rate after six months of 94.4% pointed out that this patient population could benefit from the use of excimer laser-assisted angioplasty.

Taking these results into account, it was decided to further review all CLI patients receiving infrapopliteal excimer laser-assisted angioplasty in two of the LACI-Belgium centres. The results of these clinical analyses are described in this article.

Materials and Methods
Between January 2003 and April 2005, a total of 51 CLI patients (Rutherford categories 4, 5 and 6) received excimer laser-assisted angioplasty for the treatment of below-the-knee (BTK) pathology. The mean age of the patients (28 men), was 73 years (range 48 to 93). The risk factor distribution is demonstrated in Table 1. Standard endovascular techniques were used in all patients.

Table 1: Risk Factor Distribution
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The entire occlusion was crossed with a standard guidewire, which was positioned in the distal vessel beyond the target lesion. If there was no free movement of the wire tip within the observed distal vessel, the wire was withdrawn and redirected to ensure intra-luminal position of the guidewire.

A low-profile infusion catheter was then advanced over the guidewire distal to the target lesion followed by guidewire withdrawing and contrast media injection through the infusion catheter to ensure distal run-off.

As an alternate method of recanalisation, step-by-step laser ablation (with alternated guidewire advancement and laser catheter activation (millimetre by millimetre) until complete crossing of the occlusion or stenosis) was used with three patients./>/>/>/>

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