Satiani B, Mohan Das B, Vaccaro P S, Gawron D
Department of Surgery, Grant Medical Center, Columbus, Ohio.
J Vasc Surg. 1993 May;17(5):960-5; discussion 965-6.
The purpose of this study was to obtain angiographic documentation of patency and recurrence rates after laser-assisted balloon angioplasty.
A prospective assessment of laser-assisted balloon angioplasty (LABA) was performed in 35 limbs of 33 patients with femoral popliteal atherosclerotic disease. There were 21 male and 12 female patients with a mean age of 60.6 years. Indications were intermittent claudication in 19, rest pain in nine, and ischemic ulcer/gangrene in seven limbs. There were 23 totally occluded (mean length 6 +/- 3.8 cm) and 12 stenotic arteries. LABA was achieved with a pulsed Nd:YAG laser with 10 to 25 W and a 2.2/3 mm sapphire probe, followed by balloon dilatation in all but four limbs.
Immediate technical success (< or = 50% residual stenosis) was achieved in 27 (77%) of 35 limbs. Mean ankle/brachial index improved from 0.49 to 0.80 (p < 0.05). Major complications included three perforations, three dissections, and two emboli. Two additional limbs required operation at less than 30 days for a 30-day patency rate of 71.4%. Long-term clinical and noninvasive follow-up ranged from 1 to 55 months (mean 17.68 months). Twenty-nine angiograms were obtained from 3 to 49 months after LABA. Nineteen limbs underwent at least one angiogram, seven underwent two, and three limbs underwent three angiograms. Eleven of the 19 limbs showed evidence of restenosis greater than 50%, all within 12 months. The cumulative patency rate was 71.5% at 1 month, 39.7% at 6 months, and 31.3% at 12, 24, and 36 months.
LABA with the Nd:YAG laser has a 30-day success rate of 71.4%. Angiographic follow-up demonstrates a high incidence of restenosis (> 50%), usually within 12 months. Approximately 50% of limbs eventually required reintervention within 1 year. In view of the disappointing early results, the use of LABA must remain strictly investigational.
本研究的目的是获取激光辅助球囊血管成形术后通畅率和复发率的血管造影记录。
对33例股腘动脉粥样硬化疾病患者的35条肢体进行了激光辅助球囊血管成形术（LABA）的前瞻性评估。其中男性21例，女性12例，平均年龄60.6岁。症状表现为19例间歇性跛行，9例静息痛，7条肢体有缺血性溃疡/坏疽。有23条完全闭塞的动脉（平均长度6±3.8 cm）和12条狭窄动脉。使用10至25 W的脉冲Nd:YAG激光和2.2/3 mm蓝宝石探头进行LABA，除4条肢体外，其余均随后进行球囊扩张。
35条肢体中有27条（77%）即刻技术成功（残余狭窄≤50%）。平均踝肱指数从0.49提高到0.80（p<0.05）。主要并发症包括3例穿孔、3例夹层和2例栓塞。另外2条肢体在30天内需要手术，30天通畅率为71.4%。长期临床和非侵入性随访时间为1至55个月（平均17.68个月）。LABA术后3至49个月获得了29份血管造影。19条肢体至少进行了一次血管造影，7条进行了两次，3条肢体进行了三次血管造影。19条肢体中有11条显示再狭窄证据大于50%，均在12个月内。1个月时累积通畅率为71.5%，6个月时为39.7%，12、24和36个月时为31.3%。
Nd:YAG激光辅助球囊血管成形术的30天成功率为71.4%。血管造影随访显示再狭窄发生率高（>50%），通常在12个月内。约50%的肢体最终在1年内需要再次干预。鉴于早期结果令人失望，LABA的应用必须严格保留在研究范围内。
