THERMAL LASER ANGIOPLASTY OF THE LOWER-EXTREMITIES - COMPARISON OF EARLY AND LATE EXPERIENCE

Thermal laser angioplasty (TLA) experience of 59 hospital cases in 198 8 (Group A) was compared with 113 outpatient cases treated from March 1989 to September 1991 (Group B). Angiographic success was higher in G roup B (66.4%) as compared with Group A (55.9%). Complications of majo r dissection, perforation, and local thrombus were similar. Distal emb oli (P=0.04), retroperitoneal hematomas (P=0.02), and urokinase admini stration (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 onl y 36 of Group A were. Symptomatic improvement, despite recurrence of i ntermittent claudication (IC), was present in 21% of group A and 6% of Group B subjects. Though unpredictable, the mean ankle/arm indices we re found in the following clinical categories: 100% reocclusion by ang iography, 0.46; IC same as before TLA, 0.56; IC with mild-marked impro vement, 0.70%; asymptomatic, 0.94. Average length of lesion-Group A, 1 0.5 cm versus Group B, 17 cm. This review does show improved primary s uccess rates with further operator experiences despite tackling of mor e difficult lesions. The reduction in complications is related to the decreased use of urokinase and the availability of trained support per sonnel.