Percutaneous laser angioplasty in the treatment of peripheral vascular disease.

For a long time the treatment of peripheral vascular diseases mainly was a surgical one. Improvements in drug therapy and success of PTCA have increased the interest in a more conservative therapy. So laser promised to be another tool in the percutaneous treatment of peripheral vascular diseases. First successful experiments were followed by the experience of technical problems and side effects of this new method. First clinical studies in occluded human femoral arteries were started at Stanford University in 1983. The results, published in 1985, showed that occlusive lesions in this vascular region could be successfully reopened by a percutaneous approach. But in cases of severe calcification the danger of perforation or dissection was significantly increased. Moreover the newly created channel proved to be too small for a sufficient revascularization, so that this method had to be combined with balloon angioplasty. By the development of the metalcapped "hot tip", laser energy was totally changed into thermal energy. By this new system greater channels of 2 up to 2.5 mm could be created and by the special design of the metalcap thermal injury to the arterial wall could be decreased. Nevertheless perforation occurred also with this system. Moreover, additional balloon angioplasty was still necessary in proximal segments of the femoral artery. Futural developments of greater metal heads may lead to the exclusive use of the "hot tip" especially in more distal parts. Longterm results will show, if laser angioplasty is comparable to other conventional methods like balloon angioplasty or surgery. There is still a long way to go, until the ideal of reopening atherosclerotic stenoses only by laser energy can be reached.