Thermal Laser Angioplasty of the Lower Extremities: Comparison of Early and Late Experience

Abstract

Thermal laser angioplasty (TLA) experience of 59 hospital cases in 1988 (Group A) was compared with 113 outpatient cases treated from March 1989 to September 1991 (Group B). Angiographic success was higher in Group B (66.4%) as compared with Group A (55.9%). Complications of major dissection, perforation, and local thrombus were similar. Distal emboli (P=0.04), retroperitoneal hematomas (P=0.02), and urokinase administration (P=0.03) were more prevalent in Group A. At follow-up (six to thirty-six months), 57% of Group B patients were symptom free but only 36 of Group A were. Symptomatic improvement, despite recurrence of intermittent claudication (IC), was present in 21% of group A and 6% of Group B subjects. Though unpredictable, the mean ankle/arm indices were found in the following clinical categories: 100% reocclusion by angiography, 0.46; IC same as before TLA, 0.56; IC with mild-marked improvement, 0.70%; asymptomatic, 0.94. Average length of lesion-Group A, 10.5 cm versus Group B, 17 cm.

This review does show improved primary success rates with further operator experiences despite tackling of more difficult lesions. The reduction in complications is related to the decreased use of urokinase and the availability of trained support personnel.

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