Michaels J A, Cross F W, Shaw P, Raphael M, Bowker T J, Brown S G, Adiseshiah M, Marston A
University College and Middlesex Medical School, London, UK.
Br J Surg. 1989 Sep;76(9):921-4. doi: 10.1002/bjs.1800760916.
Since December 1986, 40 laser angioplasty procedures have been performed using the energy from a pulsed NdYAG laser, delivering near infrared light (1064 nm) in 100-microseconds pulses of approximately 300 mJ per pulse, directly through a transparent sapphire tipped device. All patients had total occlusion of the superficial femoral artery and symptoms severe enough to warrant surgery, with ulceration or gangrene in eight, rest pain in 14 and severe claudication interfering with life-style in the others. The device was introduced through an antegrade puncture of the superficial or common femoral artery and laser recanalization was followed by attempted balloon angioplasty in all cases. Occlusions were a median length of 15 cm (range 2-35 cm); ten patients had previously undergone failed attempts at conventional balloon angioplasty and four had occluded femoropopliteal grafts. Thirty-seven legs of 34 patients were treated with an average of 60 J (range 10-235 J) with successful recanalization in 27 and immediate reocclusion in seven. The 20 successful recanalizations have been followed up for up to 24 months (median 7 months) with only one late occlusion at 5 months. Failed recanalization was due to poor transmission by the delivery device in the early part of the series (five cases), repeated passage of the device down a collateral branch (four cases), dissection at the site of previous surgery (two cases) or no apparent reason (two cases). Immediate reocclusion was due to very poor run off in patients with severely ischaemic limbs (three cases) or technical difficulties with balloon dilatation (two cases). Complete symptomatic relief was obtained in all the cases of radiologically successful laser angioplasty. Early surgery was required in one case following reocclusion of the artery when an angioplasty balloon failed to deflate, and one patient suffered a skin reaction thought to be due to inadequate removal of the sterilizing solution. A different sterilizing procedure is now followed. Laser angioplasty can reduce the number of patients requiring bypass surgery and improvements in the device and access methods may reduce the number of untreatable cases.
自1986年12月以来，已使用脉冲NdYAG激光的能量进行了40例激光血管成形术，该激光通过一个透明蓝宝石尖端装置直接发出近红外光（1064纳米），脉冲宽度为100微秒，每个脉冲能量约为300毫焦。所有患者的股浅动脉均完全闭塞，症状严重到足以进行手术，其中8例有溃疡或坏疽，14例有静息痛，其余患者有严重间歇性跛行影响生活方式。该装置通过股浅动脉或股总动脉顺行穿刺引入，所有病例在激光再通后均尝试进行球囊血管成形术。闭塞段的中位长度为15厘米（范围为2至35厘米）；10例患者此前常规球囊血管成形术尝试失败，4例有股腘动脉移植血管闭塞。34例患者的37条腿接受了治疗，平均能量为60焦（范围为10至235焦），27例再通成功，7例立即再闭塞。20例成功再通的患者随访了长达24个月（中位时间7个月），仅1例在5个月时出现晚期闭塞。再通失败的原因在该系列早期是由于输送装置传输不良（5例）、装置反复进入侧支分支（4例）、既往手术部位夹层形成（2例）或无明显原因（2例）。立即再闭塞是由于严重缺血肢体患者的流出道极差（3例）或球囊扩张技术困难（2例）。在所有放射学上成功的激光血管成形术病例中均获得了完全的症状缓解。1例患者在血管成形术球囊未能放气导致动脉再闭塞后需要早期手术，1例患者出现皮肤反应，认为是由于消毒溶液清除不充分所致。现在采用了不同的消毒程序。激光血管成形术可以减少需要进行搭桥手术的患者数量，并且装置和接入方法的改进可能会减少无法治疗的病例数量。
