Abstract
Purpose: To elucidate the good indication of percutaneous transluminal laser angioplasty (PTLA) for arteriosclerosis obliterans (ASO) from the outcome of PTLA. PTLA was carried out using 1064nm continuous wave Nd: YAG laser. In most cases a ceramic tip laser probe was used for contact method for laser irradiation. Twenty to 25 Watts were used and the time of lasing varied for 1 to 2 seconds. Lasing was repeated until a hole was created in the obstructive lesions. The diameter of a hole was about the diameter of the probe, which was 1.8mm. Additional balloon dilatation was done after lasing. During the period of March, 1985 through March 1993, 134 lesions in 77 patients with peripheral ASO were treated by PTLA. Initial success rate was 90.0%during the first 6 years, and 87.3%during the whole 8 years. The cumulative patency rate of total lesions was 89.7%at the end of 6 years, and 67.7%at the end of 8 years. However, those lesions, less than 10cm in length, revealed a good cumulative patency rate, which was more than 80%. The 8-year-cumulative patency rate of the iliac lesions was about 80%. There was no major complication. Dissection of arterial wall was noted in 19.4%of cases. This was caused by balloon dilatation and not by lasing. Distal embolization was noted in 7.5%of cases, but the occurrence of the complication markedly decreased after the application of aspiration of sludge before penetrating the final segment (1cm) of the occlusion. No perforation of the artery was noted. PTLA is especially indicated to peripheral occlusive arterial disease, less than 10cm in length. PTLA expanded the indication of percutaneous treatment of ASO, since lesions, in which PTA failed, could be treated successfully.
