Matsumoto T, Okamura T, Yang Y, Rajyaguru V, Morris R J
Department of Surgery, Hahnemann University, Philadelphia, PA 19102-1192.
Circulation. 1989 Nov;80(5 Pt 2):III49-53.
To clarify the efficacy of laser-assisted reconstructive vascular surgery (LARVS) for patients with severe symptoms of peripheral arterial occlusive disease, 118 ischemic legs of 104 patients were retrospectively analyzed (argon:89 and YAG:29 lasers). Of those 118 legs, 26 (22%) had tissue loss, 60 (51%) had rest pain, and 32 (27%) had incapacitating intermittent claudication. The LARVS was adequate in 60 of 118 (51%) and inadequate in 58 of 118 (49%). With argon:89 and Nd:YAG:29 lasers, respectively, 41 of 89 (46%) and 19 of 29 (66%) were adequate. In the superficial femoral artery (SFA) and popliteal artery (PA), the LARVS was adequate in 31 of 43 (72%) in segmental occlusion and in one of 31 (3%) in total-length occlusion (p less than 0.001). In segmental occlusion of the SFA, however, argon:89 and Nd:YAG:29 lasers were adequate in four of 12 (33%) and in 10 of 12 (83%), respectively (p less than 0.05). The legs in which laser was used in more than one artery (eight of eight) or in occluded grafts (proximal SFA to distal PA; three of 18) required amputation within 30 days. A follow-up study demonstrated patency in 31 of 34 (91%) 1-24 months later with the argon:89 laser and in 15 of 16 (94%) 1-6 months later with the Nd:YAG:29 laser. This study indicates that LARVS was adequate in segmental occlusions, particularly in SFA and PA lesions; however, total-length occlusions and combination arterial lesions were not appropriate for the currently available laser systems. Laser application should not be performed if a guidewire passes through the lesion, since these lesions may be more appropriately treated with balloon angioplasty.
为阐明激光辅助重建血管手术（LARVS）对有严重外周动脉闭塞性疾病症状患者的疗效，对104例患者的118条缺血腿进行了回顾性分析（氩激光：89条腿，钇铝石榴石激光：29条腿）。在这118条腿中，26条（22%）出现组织缺失，60条（51%）有静息痛，32条（27%）有致残性间歇性跛行。LARVS手术成功的有118条中的60条（51%），不成功的有118条中的58条（49%）。分别使用氩激光（89条腿）和钕钇铝石榴石激光（29条腿）时，成功的分别有89条中的41条（46%）和29条中的19条（66%）。在股浅动脉（SFA）和腘动脉（PA），节段性闭塞的43条中有31条（72%）LARVS手术成功，而全程闭塞的31条中只有1条（3%）成功（p<0.001）。然而，在股浅动脉节段性闭塞中，氩激光（12条中的4条，33%）和钕钇铝石榴石激光（12条中的10条，83%）分别成功（p<0.05）。在不止一条动脉使用激光的腿（8条中的8条）或在闭塞移植物（从股浅动脉近端到腘动脉远端；18条中的3条）中，需要在30天内进行截肢。一项随访研究表明，使用氩激光的34条腿中有31条（91%）在1 - 24个月后保持通畅，使用钕钇铝石榴石激光的16条腿中有15条（94%）在1 - 6个月后保持通畅。本研究表明，LARVS手术在节段性闭塞中是成功的，特别是在股浅动脉和腘动脉病变中；然而，全程闭塞和联合动脉病变不适用于目前可用的激光系统。如果导丝能穿过病变，则不应进行激光治疗，因为这些病变可能更适合用球囊血管成形术治疗。
