COMPARATIVE LONG-TERM RESULTS OF LASER-ASSISTED BALLOON ANGIOPLASTY AND ATHERECTOMY IN THE TREATMENT OF PERIPHERAL VASCULAR-DISEASE

BACKGROUND: Early results of laser-assisted balloon angioplasty (LABA) and peripheral directional atherectomy (PDA) are encouraging. The tru e value of these procedures has remained in doubt, however, because of the absence of data on long-term objective patency rates. PATIENTS AN D METHODS: From August 1988 through October 1993, LABA and PDA were pe rformed on 151 limbs of 124 patients. Presenting symptoms were mild-to -severe claudication in 128 Limbs (63 LABA, 65 PDA) and rest pain or n ecrosis in 23 (7 LABA, 16 PDA). Seventy-seven percent of the atheroscl erotic lesions were localized in the iliofemoral tract (77% LABA, 76% PDA). Seventy limbs were treated with LABA and 81 with PDA. RESULTS: I nitial hemodynamic and arteriographic success was achieved in 46 LABA limbs (66%) and 75 PDA limbs (93%) (P<0.002). Mean follow-up tvas 16 /- 2 months after LABA and 18 +/- 1 months after PDA. During this time , 32 failures were recorded in limbs treated with LABA, and 29 in limb s treated with PDA. The patency rate at 40 mouths was 23% in the LABA. group and 45% in the PDA group (P<0.005). Patency rates were not affe cted by the length or site of the arterial lesion or the runoff score. CONCLUSIONS: PDA had a better long-term patency rate than LABA, but l ong-term results were dismal with both techniques. PDA appears to have a limited role and LABA no role in the treatment of lower extremity o cclusive disease.