McCarthy W J, Vogelzang R L, Nemcek A A, Joseph A, Pearce W H, Flinn W R, Yao J S
Department of Surgery, Northwestern University Medical School, Chicago, IL.
J Vasc Surg. 1991 May;13(5):607-14. doi: 10.1067/mva.1991.27559.
The ability to ablate atheroma without generating heat makes the excimer laser wavelength a promising intraluminal technique for the treatment of arterial occlusive disease. This series reviews a preliminary experience treating patients with superficial femoral arterial disease admitted with limb-threatening ischemia or claudication. Twenty-six diseased superficial femoral arteries (5 stenotic and 21 occluded) were treated in 23 consecutive patients. Patients with claudication (18) reluctant to undergo bypass or with limb-threatening ischemia (8) at extremely high risk for surgery were included. There were 10 men and 13 women with a mean age of 67 years. A 308 nm excimer laser with an over-the-wire catheter (19) or balloon-centered end-on catheter (7) was used followed by balloon angioplasty. Twenty-four procedures were performed percutaneously, and two were performed with the vessel open in the operating room. Technical success, defined as disobliteration confirmed by angiography and greater than 0.15 increase of the ankle/brachial index, was achieved in 15 of 26. Eleven of 21 occlusions (52%) and four of five stenoses (80%) were opened. Only two of 11 lesions longer than 10 cm were successfully treated. Unsuccessful attempts (technical failure) occurred in 11 of 26 patients and resulted in four elective and one emergency femoral-popliteal bypass. Five patients were discharged with their claudication unchanged, and one had an elective amputation. Six arterial perforations with three arteriovenous fistulas occurred, all resolved without operation. No unanticipated limb loss occurred. In the 15 successful cases, the mean ankle/brachial index increase was 0.34. Seven (47%) of these 15 remain patent with a mean follow-up of 9.5 months (1.5 to 14 months).(ABSTRACT TRUNCATED AT 250 WORDS)
准分子激光波长在不产生热量的情况下消融动脉粥样硬化斑块的能力，使其成为一种治疗动脉闭塞性疾病的很有前景的腔内技术。本系列回顾了对因肢体威胁性缺血或间歇性跛行入院的股浅动脉疾病患者的初步治疗经验。对23例连续患者的26条病变股浅动脉（5条狭窄，21条闭塞）进行了治疗。纳入了因不愿接受搭桥手术而患有间歇性跛行的患者（18例）或因手术风险极高而患有肢体威胁性缺血的患者（8例）。有10名男性和13名女性，平均年龄67岁。使用了带有金属丝导管的308纳米准分子激光（19例）或球囊中心端对端导管（7例），随后进行球囊血管成形术。24例手术为经皮操作，2例在手术室开放血管的情况下进行。技术成功定义为血管造影证实血管再通且踝/臂指数增加超过0.15，26例中有15例实现了技术成功。21例闭塞中有11例（52%）开通，5例狭窄中有4例（80%）开通。26例患者中有11例尝试失败（技术失败），导致4例择期和1例急诊股腘动脉搭桥手术。5例患者出院时间歇性跛行症状未改善，1例进行了择期截肢。发生了6例动脉穿孔，伴有3例动静脉瘘，均未手术自行缓解。未发生意外肢体丢失。在15例成功病例中，踝/臂指数平均增加0.34。这15例中有7例（47%）保持通畅，平均随访9.5个月（1.5至14个月）。（摘要截取自250字）
