Ashley S, Brooks S G, Gehani A A, Kester R C, Rees M R
Eur J Vasc Surg. 1994 Jul;8(4):494-501. doi: 10.1016/s0950-821x(05)80971-5.
A conventional continuous wave Nd-YAG medical laser system delivered by transparent sapphire tipped optical fibres was used for percutaneous recanalisation of 32 chronic femoropopliteal occlusions in 27 patients (19 men, eight women; median age 68 years, range 46-83 years). Twenty-four patients had severe intermittent claudication and three had critical ischaemia. The median occlusion length was 8 cm (range 3-35 cm) and lesions were not negotiable by guidewire. Laser energy was delivered at powers of 10-15 Watts using intermittent 1 second emissions (mean total energy 315 Joules, range 30-1015]). The sapphire tips used were 1.8 to 3.0 mm diameter. After laser recanalisation adjunctive balloon dilatation was necessary to widen the resulting lumen. All patients received anti-platelet therapy. Initial clinical success was achieved in 22 limbs (69%) with symptomatic relief and increase in mean (+/- S.D.) ankle-brachial pressure ratio from 0.52 (+/- 0.25) to 0.80 (+/- 0.21) [Mann-Whitney U, p < 0.001]. Recanalisation was unsuccessful in all calcified lesions (four cases). There was a high incidence of vessel perforation (28%) and wall dissection (25%). Emergency surgery was not required after failed procedures. The median follow-up was 12 months (range 6-20 months). By 6 months, 15 of 22 successfully recanalised lesions (68%) had reoccluded. The cumulative primary patency at 1 year was only 12%. These disappointing results do not support routine use of this system. Clearly, modifications of the laser/delivery system or the technique, or both, are required. The aim should be to achieve sole laser recanalisation without concomitant balloon dilatation.
采用由透明蓝宝石头光纤传输的传统连续波Nd-YAG医用激光系统，对27例患者（19例男性，8例女性；年龄中位数68岁，范围46 - 83岁）的32处慢性股腘动脉闭塞病变进行经皮再通治疗。24例患者有严重间歇性跛行，3例有严重缺血。闭塞长度中位数为8 cm（范围3 - 35 cm），病变无法通过导丝通过。使用1秒间歇性发射，以10 - 15瓦的功率输送激光能量（平均总能量315焦耳，范围30 - 1015焦耳）。所用蓝宝石头直径为1.8至3.0毫米。激光再通后，需要进行辅助球囊扩张以扩大形成的管腔。所有患者均接受抗血小板治疗。22条肢体（69%）取得了初步临床成功，症状缓解，平均（±标准差）踝肱压比值从0.52（±0.25）增加到0.80（±0.21）[曼-惠特尼U检验，p < 0.001]。所有钙化病变（4例）再通均未成功。血管穿孔发生率高（28%），血管壁夹层发生率高（25%）。手术失败后无需急诊手术。随访中位数为12个月（范围6 - 20个月）。到6个月时，22处成功再通病变中有15处（68%）再次闭塞。1年时的累积一期通畅率仅为12%。这些令人失望的结果不支持常规使用该系统。显然，需要对激光/传输系统或技术，或两者进行改进。目标应该是仅通过激光再通而无需同时进行球囊扩张。
