Laser surgery in enclosed spaces: a review.

We describe the results of experiments carried out in the arteries of dogs, rabbits, guinea pigs, and humans, normal or atheromatous, calcified, or not, with the application of the argon and CO2 laser, in vitro or in vivo, directly or indirectly. Similarly, we present the results of laser effects when radiation is delivered through a special catheter with the purpose of producing aortic insufficiency, opening pulmonary valvular stenosis, desobstructing carotid and coronary obstruction induced in dogs as well as atheromatous obstructions in human amputated legs. Arterial wall perforation was present in 50% of all cases. We suggest four options in order to diminish this adverse result: (1) the use of coherent optical bundles which will allow the proper guiding of the laser beam, (2) the construction of a special catheter for proper handling of the laser-carrying fiber, (3) a combination of optical and computer programs which will aid to identify calcified regions, and (4) the use of dyes which will be strongly and selectively absorbed by the atheromas and which will thus allow their destruction at low laser powers.