Laird John R, Zeller Thomas, Gray Bruce H, Scheinert Dierk, Vranic Mitar, Reiser Christopher, Biamino Giancarlo
Washington Hospital Center, Washington, DC 20010, USA, and Herzzentrum, Universität Leipzig, Germany.
J Endovasc Ther. 2006 Feb;13(1):1-11. doi: 10.1583/05-1674.1.
To evaluate the effectiveness of laser-assisted angioplasty for patients with critical limb ischemia (CLI) who were poor candidates for surgical revascularization.
A prospective registry at 14 sites in the US and Germany enrolled 145 patients with 155 critically ischemic limbs; the patients were poor candidates for bypass surgery owing to inadequate target vessel or saphenous vein, prohibitive cardiac disease, or significant comorbidities (ASA class 4). Additional comorbid risk factors included diabetes in 66%, hypertension in 83%, previous stroke in 21%, and myocardial infarction in 23%. Endovascular treatment included guidewire traversal and excimer laser angioplasty followed by balloon angioplasty with optional stenting.
Occlusions were present in 92% of limbs. A mean of 2.7+/-1.4 lesions were treated per limb; the total median treatment length was 11 cm (mean 16.2, range 0.2-123). Stents were implanted in 45% of limbs. Procedural success, defined as <50% residual stenosis in all treated lesions, was seen in 86% of limbs. At 6-month follow-up, limb salvage was achieved in 110 (92%) of 119 surviving patients or 118 (93%) 127 limbs.
Excimer laser-assisted angioplasty for CLI offers high technical success and limb salvage rates in patients unfit for traditional surgical revascularization.
评估激光辅助血管成形术对那些不适合进行手术血运重建的严重肢体缺血（CLI）患者的有效性。
美国和德国14个地点的一项前瞻性登记研究纳入了145例患者的155条严重缺血肢体；由于靶血管或大隐静脉不足、严重心脏病或显著合并症（美国麻醉医师协会4级），这些患者不适合进行搭桥手术。其他合并风险因素包括66%的患者患有糖尿病、83%的患者患有高血压、21%的患者曾有中风、23%的患者曾有心肌梗死。血管内治疗包括导丝穿过和准分子激光血管成形术，随后进行球囊血管成形术并酌情置入支架。
92%的肢体存在闭塞。每条肢体平均治疗2.7±1.4处病变；治疗总长度中位数为11厘米（平均16.2厘米，范围0.2 - 123厘米）。45%的肢体置入了支架。定义为所有治疗病变残余狭窄<50%的手术成功率在86%的肢体中可见。在6个月的随访中，119例存活患者中的110例（92%）或127条肢体中的118条（93%）实现了肢体挽救。
对于不适合传统手术血运重建的CLI患者，准分子激光辅助血管成形术具有较高的技术成功率和肢体挽救率。
