Complications of Laser-Assisted Angioplasty: Recognition,Classification and Treatment

Abstract

No adequate reports from signifi cant patient populations exist on the nature and extent of complications from peripheral laser-assisted angio plasty. To define and enumerate these adverse reactions, data were col lected from 770 procedures per formed on 400 patients in a sixteen- month period. Arteries treated were: 133 iliac (17%), 418 femoral (54%), 121 popliteal (16%), 73 tibial/pero neal (9%), and 25 grafts (3%).

Complications, similar to those of standard angioplasty, were identified and classified according to cause: la ser, access method, or the angioplasty procedure with its attendant equip ment (balloons, etc). The types of morbidity observed were: perfora tion/dissection (54 cases, 7%), acute thrombosis (38, 5%), spasm (5, 0.7%), false aneurysm at the punc ture site (15, 2%), embolism (1, 0.1%), and hematoma (115, 15%).

Because perforation is the most significant intraoperative complica tion, a standardized system has been devised to bring uniformity to its doc umentation and reporting. The three-part classification is based on the arterial pathology producing the probe's deviation and on the ramifi cations of the aberrancy.

In addition to recognition and classification, prudent treatment of an evolving complication can often salvage the procedure. Treatment modalities for the common complica tions and preventive measures to avert them have been identified and incorporated into the treatment pro tocol.

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References

Abela GS , Seeger JM , Barbieri E. , et al: Laser angioplasty with angioscopic guidance in humans. J Am Coll Cardiol 8:184-192, 1986.

Choy DJ , Sterter SH , Myles RK , et al: Human coronary laser recanalization. Clin Cardiol 7:377-381, 1984.

Cumberland DC , Sanborn T. , Taylor DI , et al: Percutaneous laser thermal angioplasty: Clinical experience in peripheral artery occlusions. J Am Coll Cardiol 2:211A, 1986.

Cumberland DC , Sanborn TA , Taylor DI , et al: Percutaneous laser thermal angioplasty: Initial clinical results with a laser probe in total peripheral artery occlusions . Lancet 1:1457-1459, 1986 .

Cumberland DC , Taylor DI , Proctor AE : Laser-assisted percutaneous angioplasty: Initial clinical experience in peripheral arteries. Clin Radiol 37:423-428, 1986.

Ginsberg R. , Wexler L. , Mitchell RS , et al: Percutaneous transluminal laser angioplasty for treatment of peripheral vascular disease: Clinical experience with sixteen patients. Radiology 156:619-624, 1985.

Sanborn TA , Faxon DP , Kellett MA , et al: Percutaneous coronary laser thermal angioplasty. J Am Coll Cardiol 8:1437-1440, 1986.

Sanborn TA , Greenfield AJ , Guben JK , et al: Human percutaneous and intraoperative laser thermal angioplasty: initial clinical results as an adjunct to balloon angioplasty. J Vasc Surg 5:83-90, 1987.

Diethrich EB , Rozaci J. , Timbadia E. , et al: Laser angioplasty — a surgical perspective. Medica Mundi 32:127-132, 1987.

10.

Diethrich EB , Rozaci J. , Timbadia E. , et al: Argon laser-assisted peripheral angioplasty . Vasc Surg 22:77-87, 1988.

11.

Diethrich EB , Timbadia E. , Rozaci J. , et al: Laser-assisted iliac artery angioplasty . Am J Surg 1988; in press.

12.

Diethrich EB , Timbadia E. , Bahadir I. : Peripheral laser-assisted angioplasty. In: Proceedings of the XXVI World Congress of the International College of Surgeons, ed. by Montorsi W. Milan: Monduzzi Editore, 1988, pp 433-436.

13.

Diethrich EB , Timbadia E. , Bahadir I. : Peripheral laser angioplasty. In: Advances in Laser Medicine I: First German Symposium on Laser Angioplasty, ed. by Biamino G , Muller GJ. Berlin, West Germany: Ecomed Verlagsgesellschaft, 1988, pp. 217-226.

14.

Cumberland DC , Taylor DI , Procter AE : Percutaneous laser angioplasty. Initial clinical experience. Ann Radiol (Paris) 29:215-218, 1986.

15.

Cumberland DC , Sanborn TA , Taylor DI , et al: Percutaneous laser thermal angioplasty: Initial clinical results with a laser probe in total peripheral artery occlusions . Lancet 1:1457-1459, 1986 .

16.

Lee G. , Ikeda RM , Theis JH , et al: Acute and chronic complications of laser angioplasty: Vascular wall damage and formation of aneurysms in the atherosclerotic rabbit. Am J Cardiol 53:290-293, 1984.

17.

Lee G. , Ikeda RM , Chan MC , et al: Limitations, risks and complications of laser recanalization: A cautious approach warranted. Am J Cardiol 56:181-185, 1985.

18.

Dries DJ , Lawrence PF , Syverud J. , et al: Response of atherosclerotic aorta to argon laser. Lasers Surg Med 5:321-326, 1985.

19.

Isner JM , Donaldson RF , Funai JT , et al: Factors contributing to perforations resulting from laser coronary angioplasty: Observations in an intact human postmortem preparation of intraoperative laser coronary angioplasty. Circulation 72 (Suppl II):II-191-199, 1985.

20.

Labs JD , Merillat JC , Williams GM : Analysis of solid phase debris from laser angioplasty: Potential risks of atheroembolism. J Vasc Surg 7:326-335, 1988.

21.

Choy DS , Stertzer S. , Loubeau JM , et al: Embolization and vessel wall perforation in argon laser recanalization . Lasers Surg Med 5:297-308, 1985.

22.

Sanborn TA , Faxon DP , Haudenschild C. , et al: Experimental angioplasty: Circumferential distribution of laser thermal energy with a laser probe. J Am Coll Cardiol 5:934-945, 1985.

23.

Abela GS , Norman SJ , Cohen D. , et al: Laser recanalization of occluded atherosclerotic arteries: An in vivo and in vitro study. Circulation 71:403-411, 1985.

24.

Sanborn TA , Haudenschild CC , Garber GR , et al: Angiographic and histologic consequences of laser thermal angioplasty: Comparison with balloon angioplasty. Circulation 75:1281-1286, 1987.

25.

Sigwart U. , Puel J. , Mirkovitch V. , et al: Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 316:701-706, 1987.

26.

Schatz RA , Palmaz JL : Intravascular stents for angioplasty. Cardio 12:27-31, 1987.