Laser atherectomy in the treatment of peripheral arterial occlusive disease

RANDULA, Antonín, M THIEME, M SCHWENK, Lenka VEVERKOVÁ, Ondřej ČÍP and Zdenek BUCHTA. Laser atherectomy in the treatment of peripheral arterial occlusive disease. In Laser Helsinki 2012 International Congress. 2012. Available from: https://dx.doi.org/10.1016/S1572-1000(12)70025-X.

Basic information

• Original name: Laser atherectomy in the treatment of peripheral arterial occlusive disease
• Authors: RANDULA, Antonín, M THIEME, M SCHWENK, Lenka VEVERKOVÁ, Ondřej ČÍP and Zdenek BUCHTA.
• Edition: Laser Helsinki 2012 International Congress, 2012.

Other information

• Original language: English
• Type of outcome: Proceedings paper
• Field of Study: 30200 3.2 Clinical medicine
• Country of publisher: Finland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/S1572-1000(12)70025-X
• Tags: International impact, Reviewed

Abstract

Background: Peripheral occlusive arterial disease (PAD) represents a highly prevalent chronic disorder among the population.Clinically, we can divide it into four stages: I-IV according to Fountaine. In the critical stage of limb ischemia the preferred methods of first choice minimally invasive revascularisation procedures - PTA with or without stenting. Atherectomy represent an adjunctive technique that allows to directly remove the intravascular atheromatous plaques. We used the pulse laser beam delivered in a fine, flexible fiberoptic catheter that removes the atheromatous plaque in the artery wall and allows the blood stream to oxygenate the ischemic tissue- the excisional, rotational atherectomy technique based on mechanical removing of the plaque by rotating knife located in a thin catheter Materiál: In the year 2011, 346 patients with PAD in clinical stage IIb-IV were treated in the Hospital of Sonneberg using endovascular PTA. Out of this number 12 patients undewent atherectomy. Atherectomy was combined with balloon angioplasty in all the 12 cases. Excisional (rotational) atherectomy (1.6%) was performed six times and laser atherectomy (1.6%) was exhibited another six times. Clinical examination, duplex ultrasound and ankle-brachial index were performed in a standard way: before the treatment, during the first few days after the procedure and at six-month follow-up.In the year 2011, six patients (5 men, 1 woman) in the average age of 73 were treated with laser. After each atherectomy, PTA was performed. Excisional atherectomy was performed using the Turbohawk Plaque Excision System. In the year 2011, six patients (4 men, 2 women) in the average age of 69 were treated with excisional atherectomy. In all the cases, the primary crossing technique with the guiding wire insertion was used and PTA was additionally performed. Conclusion: The recent mechanical interventional endovascular systems allow in majority of the cases good interventional results. Also, the corresponding rapidity of the treatment is an advantage.In the femoropopliteal area, the mechanical (rotational) atherectomy allows similar results as the laser angioplasty, however, below the knee, , the laser angioplasty offers more interventional capabilities (due to the small diameter of the vessel and the impossibility of guidewire insertion).We suppose that the laser-assisted angioplasty is a useful technique in cases where the used mechanical methods represent higher risk of penetration or dissection as they do in popliteal area or by hard plaques by the dense calcinosis. A limitation of this study is given by the small sample size and short follow-up time. The laser assisted angioplasty represents a competent therapy option for the selected patients constituing an addition to the conventional, minimal invasive techniques.