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Online ISSN 1827-1847
De Freitas D. J., Stoner M. C.
Department of Vascular and Endovascular Surgery East Carolina University, Greenville, NC, USA
Laser atherectomy has been used to treat peripheral arterial disease for the past 20 years but has yet to be widely accepted. Some of the skepticism arises from earlier versions of the laser that caused significant thermal injury to the vessel resulting in very high complication rates. Lasers, catheter technology and our understanding of the interactions between light, blood and tissues has advanced significantly over the past 20 years. The current excimer laser uses a pulsed beam that causes little thermal damage and has the ability to cross complex calcified lesions. Unfortunately, technical success has not been associated with good long term patency. Most vessels are not treatable with laser alone and require concomitant angioplasty and stenting. Multiple reinterventions are often needed to obtain the desired clinical outcome. Balloon angioplasty has been shown to have similar patency rates despite the improved technical success with the laser. This makes support of laser therapy difficult as a first line treatment in all patients. The question then becomes what is the role for laser atherectomy? Is the remarkable science and potential applications of lasers in peripheral arterial disease underappreciated or do we need to limit its use to a small subset of patients?