The use of lasers in vascular and cardiac surgery. Clinical review.

Use of lasers is routine in medical fields such as ophthalmology and dermatology, but in spite of intensive research in recent years, its role in cardiac and vascular surgery still remains to be determined. Laser energy can vaporize atherosclerotic plaques in human arteries obtained at necropsy. Fiberoptic catheters have been constructed to deliver the laser energy to atheromas at a distance from the arteriotomy. The healing of the arterial wall after laser treatment is rapid and results in complete reendothelialization. Lasers have been used in patients undergoing coronary surgery as well as peripheral vascular reconstructions. In some cases, the percutaneous approach has also been used. In these clinical series, the laser treatment was in almost all cases followed by either transluminal balloon angioplasty or by-pass operation. Complications after laser treatment include vessel perforation, reocclusions, thrombosis, or aneurysm formation. The development of more advanced fiberoptic catheters and better understanding of dosimetric parameters are promising features to avoid these complications as well as development of methods for steering of the laser catheter itself and means for "real time" diagnosis (e.g. angioscopes, spectroscopic diagnosis). The future use of lasers in cardiac and vascular surgery seems promising, especially as an alternative to balloon angioplasty.