末梢動脈疾患に対するレーザー治療

抄録

Argon laser angioplasty was performed in 74 patients with the occlusive diseases of the peripheral arteries by metal tip probe with thermal feedback control system. Primary clinical success was achieved in 75 (81%) of all 93 lesions. In 65 (88%) of 75 lesions with clinical success, additional dilatation was carried out with a balloon catheter. The clinical success rate was significantly higher (p<0.01) in the lesions (97%) shorter than 10cm than in the lesions (71%) longer than 10cm in 51 femoropopliteal lesions, whereas the clinical success rate was significantly lower (p<0.01) in longer lesions (?5cm) than in shorter lesions (<5cm) in 42 iliac lesions. These were no complications required emergency operation. Reocclusion tended to occur more often in patients with newly dissection by additional balloon dilatation, hypertension or diabetes mellitus, and poor distal runoff. At 68 months of follow up, the cumulative patency rate (CPR) was 90% in 65 cases with clinical success. In the 35 stenotic and 30 occlusive lesions, the CPR were 94% and 85%, respectively. In 37 femoropopliteal lesions, the CPR were 91% In recanalized lesions shorter than 10cm and was 64% in recanalized lesions longer than 10cm. Thus, laser angioplasty was safe and effective to increase the initial success rate for lesions that were difficult to treat by balloon angioplasty. Angioscopy and intravascular ultrasound imaging were useful for the observation of the newly recanalized channel by lasing. These results suggested that laser angioplasty might be a useful treatment for patients with chronic peripheral arterial diseases and improve the long-term patency rate by diminishing restenosis more than conventional balloon angioplasty.