Excimer Laser-Assisted Recanalization of Long, Chronic Superficial Femoral Artery Occlusions

Abstract

Purpose: To examine the safety and efficacy of excimer laser-assisted angioplasty (ELA) for recanalization of superficial femoral artery (SFA) occlusions. Methods: Data were analyzed from 318 consecutive patients (207 men; mean age 64.2 ± 10.7 years, range 33–91) who underwent ELA of 411 SFAs with chronic occlusions averaging 19.4 ± 6.0 cm in length. More than 75% of patients had severe claudication (category 3). Critical lower limb ischemia with rest pain or minor tissue loss was present in 6 and 15 patients, respectively. The mean ankle brachial index (ABI) before and after exercise was 0.62 ± 0.15 and 0.40 ± 0.18, respectively. Results: The initial attempt (crossover approach 89.7%, antegrade 6.6%, transpopliteal 3.6%) to cross the occlusion with an excimer laser catheter was successful in 342 (83.2%) of 411 limbs. A secondary attempt performed in 44 of 69 failed cases was successful in 30 limbs, increasing the technical success rate to 90.5% (372/411). Complications included acute reocclusion (4, 1.0%), perforation (9, 2.2%), and distal thrombosis/embolization (16, 3.9%). Postprocedurally, 219 (68.8%) patients were asymptomatic; mild (category 1) or moderate (category 2) claudication remained in 53 (16.6%) and 26 (8.2%) patients, respectively. The primary patency at 1 year was 33.6%. In the majority of patients, reocclusion was treatable on an outpatient basis. The 1-year assisted primary and secondary patency rates were 65.1% and 75.9%, respectively. Conclusions: Long SFA occlusions can be recanalized safely and successfully by ELA. However, to maintain patency and quality of life, intensive surveillance using objective testing followed by prompt repeat intervention are mandatory.