Laser-assisted transluminal angioplasty of the superficial femoral and popliteal arteries.

During an initial 1-year experience with percutaneous laser-assisted balloon angioplasty at the Vancouver General Hospital, 9 of 61 patients considered suitable for intervention because of arterial occlusive disease were selected for laser treatment. The neodymium-YAG laser with a contact sapphire tip was chosen because the probes and tips are reusable, thereby reducing the cost per patient. The patients had either severe limiting claudication or pain at rest, involving the superficial femoral or popliteal artery. One of the patients had lesions in both legs, making a total of 10 lesions. In 8 of the 10 lesions, treatment initially was successful. In the other two instances, the laser perforated the arterial wall, but the patients suffered no ill effects; repair by bypass surgery was uncomplicated. Another patient had distal thrombosis at the time of angioplasty of the popliteal artery; this responded to fibrinolytic therapy and subsequent balloon angioplasty of the peroneal artery. The initial 80% success rate was reasonable, considering that all these patients would otherwise have undergone bypass surgery. One patient had recurrent stenosis 5 months after the procedure. The other seven had good results with relief of symptoms. However, follow-up has been short (mean 4.9 months), the longest being only 11 months.