Laser atherectomy for the treatment of peripheral arterial disease

• Published in: Annals of vascular surgery Vol. 44; pp. 269 - 276
• Main Authors: Mallios, Alexandros, MD, Blebea, John, MD, MBA, Buster, Bryan, MD, Messiner, Ryan, MD, Taubman, Kevin, MD, MA, Harry, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-10-2017
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Angioplasty, Balloon - instrumentation; Atherectomy - adverse effects; Atherectomy - instrumentation; Critical Illness; Electronic Health Records; Female; Hospitals, University; Humans; Intermittent Claudication - diagnosis; Intermittent Claudication - therapy; Ischemia - diagnosis; Ischemia - therapy; Lasers - adverse effects; Limb Salvage; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Paris; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - therapy; Retrospective Studies; Risk Factors; Stents; Surgery; Tertiary Care Centers; Time Factors; Treatment Outcome; endovascular treatment; peripheral arterial disease; laser atherectomy
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2017.04.013

Abstract OBJECTIVE To investigate the clinical results of laser atherectomy in the treatment of peripheral arterial disease. METHODS Retrospective analysis of consecutive patients undergoing laser atherectomy at a single institution during a seven year period by vascular surgeons and interventional cardiologists in a tertiary university-affiliated hospital. Clinical data was retrieved from patient charts and hospital electronic medical records along with the associated arteriograms. RESULTS A total of 461 lesions in 343 limbs were treated in 300 patients with a mean age of 70 years. The indication was critical limb ischemia (CLI) with rest pain or tissue loss in 227 (66%) of interventions and claudication in 116 (34%). All procedures included an associated balloon angioplasty while stenting was performed in 33%.Technical success was achieved in 99% with only 2 (<1%) cases with an acute procedure-related complication requiring surgical intervention. At a mean follow up of 28 months (range 1-87 months – median 24 months), 156 patients (45%) became asymptomatic or achieved significant clinical improvement (resolution of tissue loss or rest pain), 60 (17%) remained with CLI, 30 (9%) had a major proximal amputation, and 18 (5%) had a minor amputation. Freedom from major amputation was 90% at five years by life table analysis. Univariate statistical analysis demonstrated the risk of a major amputation to be associated with diabetes, hemodialysis and tissue loss (P<0.05 to P<0.005) while multivariate logistic regression analysis indicated diabetes to be overwhelmingly important (RR: 4.84, 95% CI: 1.1-21.3, P < 0.05). In a similar manner, multivariate analysis indicated dialysis (RR: 2.46, 95% CI: 1.01-5.98, P < 0.05) and critical limb ischemia (RR: 2.27, 95% CI: 1.42-3.65, P < 0.01) were associated with higher likelihood for lack of clinical improvement. There was no difference in major amputation rates between surgeons and interventional cardiologists (RR: 1.5, 95% CI:, P<0.1) although it was three times more likely for the patients treated by surgeons to suffer from CLI (OR: 3.2, 95% CI: 1.9-5.4, P < 0.0001). CONCLUSION Laser atherectomy is a safe and useful adjunct in limb salvage. Diabetics have much higher probability of requiring a proximal amputation while those on dialysis and with critical limb ischemia are least likely to gain clinical benefit.