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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1998 April;39(2):131-5

lingua: Inglese

Nd Yag ­laser angio­plas­ty: a safe pro­ce­dure in periph­er­al vas­cu­lar sur­gery

Nazzal M., Kaidi A. A.*, Thanh Ph.*

From ­the Departments of Surgery/Vascular Sec­tion University of Iowa Hospital ­and Clinical, Iowa City, IA, USA
* North Oakland Medical Center, Pontiac, MI, ­USA


Background. Thirty-­three ­patients (34 ­limbs) ­with periph­er­al vas­cu­lar occlu­sive dis­ease ­were treat­ed ­with Nd Yag ­laser assist­ed angio­plas­ty ­over a ­three-­year peri­od (1989-1991).
Methods. Sixteen ­males ­and 17 ­females ­were includ­ed in ­the ­study. The ­mean ­age of ­all ­patients ­was 70.29 (44-86) ­years. Twenty-­two (66.7%) ­patients ­were smok­ers, 21 (63.6%) ­had cor­o­nary ­artery dis­ease ­and 14 (42.4%) ­had dia­betes mel­lit­us. Thirty-­three ­patients (100%) ­had dis­abling inter­mit­tent claud­i­ca­tion, 20 ­patients (60.6%) ­had ­rest ­pain, 2 ­patients (6.1%) ­had ­ulcers ­and 10 ­patients (30.3%) ­had gan­gre­nous chang­es. Thirty-­nine ves­sels ­were treat­ed; 34 (87.2%) super­fi­cial femo­ral arter­ies, 4 (10.3%) pop­li­teal arter­ies ­and 1 exter­nal ­iliac ­artery. Eleven (28.2%) ves­sels ­were total­ly occlud­ed ­and ­the remain­ing 28 (71.8%) ves­sels ­had ­high ­grade sten­o­sis of ­more ­than 90%. The ­mean pre­op­er­a­tive ­ABI Index ­was 0.23±12.
Results. The pre­op­er­a­tive angio­gram ­showed ­poor ­out-­flow in 24 (70.6%) extrem­ities, 1 ­patent dis­tal ves­sel in 7 extrem­ities (20.6%) ­and at ­least 2 ves­sels in 3 extrem­ities (8.8%). The ­patients ­were fol­lowed up ­for a peri­od of 9.9 ­months (20 ­days-30 ­months). The pro­ce­dure ­could ­not be ­done in 2 extrem­ities. All ­the remain­ing 32 extrem­ities ­had pat­ent ves­sels at ­the ­end of ­the pro­ce­dure. Fifteen (48.4%) ­patients stat­ed ­that ­they ­improved ­but ­remained symp­to­mat­ic. Twelve (38.7%) ­were com­plete­ly asymp­to­mat­ic, 3 (9.7%) ­patients ­had no ­change in ­their symp­toms ­and 2 ­patients wors­ened at ­the ­end of ­the fol­low-up peri­od. The ­mean post­op­er­a­tive ­ABI ­was 0.78. Bleeding ­from ­the punc­ture ­site requir­ing clo­sure ­was ­the ­most com­mon com­pli­ca­tion of ­the pro­ce­dure in 6 ­patients (19.4%). Angioplasty in 5 of ­these ­patients ­was ­done by ­the ­open tech­nique. Other com­pli­ca­tions includ­ed hemat­o­ma in 3 (9.7%) ­patients ­and ­one ­case (3%) of ­artery per­fo­ra­tion. Among ­those ­who ­remained asymp­to­mat­ic at ­the ­end of ­the fol­low-up peri­od ­the ­mean ­change in ­ABI ­was 0.625±0.19, ­those ­who ­improved ­but ­remained symp­to­mat­ic ­the ­mean ­ABI ­change ­was 0.43±0.25 ­while ­those ­whose symp­toms ­did ­not ­change ­or wors­ened ­the ­mean ­ABI ­change ­was 0.12±0.13. The ­ABI ­change in ­the ­first ­two ­groups ­was sig­nif­i­cant­ly high­er ­than ­the ­last ­one (p<0.006 ­and p<0.001 respec­tive­ly). There ­was no sig­nif­i­cant dif­fer­ence in ­the out­come of ­LABA ­between ste­nosed ­and occlud­ed ves­sels. Smoking ­was sig­nif­i­cant­ly high­er in ­the symp­to­mat­ic ­patients (7/20) com­pared to ­those ­who ­were asymp­to­mat­ic 5/12, p<0.02. Diabetes mel­lit­us, car­di­o­vas­cu­lar dis­ease ­and ­the pre­op­er­a­tive ­ABI ­were ­not sig­nif­i­cant var­i­ables in ­the out­come of angio­plas­ty.
Conclusions. In con­clu­sion, Nd Yag ­laser assist­ed angio­plas­ty is a ­safe pro­ce­dure. It ­could ­relieve symp­toms in 87.1% of cas­es. Change in ­the ­ABI ­and smok­ing ­are pre­dic­tive of ­the suc­cess of ­the pro­ce­dure.

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