ND-YAG LASER ANGIOPLASTY - A SAFE PROCEDURE IN PERIPHERAL VASCULAR-SURGERY

Background. Thirty-three patients (34 limbs) with peripheral vascular occlusive disease were treated with Nd Yag laser assisted angioplasty over a three-year period (1989-1991). Methods. Sixteen males and 17 fe males were included in the study, The mean age of all patients was 70. 29 (44-86) years. Twenty-two (66.7%) patients were smokers, 21 (63.6%) had coronary artery disease and 14 (42.4%) had diabetes mellitus. Thi rty-three patients (100%) had disabling intermittent claudication, 20 patients (60.6%) had rest pain, 2 patients (6.1%) had ulcers and 10 pa tients (30.3%) had gangrenous changes. Thirty-nine vessels were treate d; 34 (87.2%) superficial femoral arteries, 4 (10.3%) popliteal arteri es and 1 external iliac artery. Eleven (28.2%) vessels were totally oc cluded and the remaining 28 (71.8%) vessels had high grade stenosis of more than 90%. The mean preoperative ABI Index was 0.23+/-12. Results . The preoperative angiogram showed poor out-flow in 24 (70.6%) extrem ities, 1 patent distal vessel in 7 extremities (20.6%) and at least 2 vessels in 3 extremities (8.8%). The patients were followed up for a p eriod of 9.9 months (20 days-30 months). The procedure could not be do ne in 2 extremities. All the remaining 32 extremities had patent vesse ls at the end of the procedure. Fifteen (48.4%) patients stated that t hey improved but remained symptomatic. Twelve (38.7%) were completely asymptomatic, 3 (9.7%) patients had no change in their symptoms and 2 patients worsened at the end of the follow-up period. The mean postope rative ABI was 0.78. Bleeding from the puncture site requiring closure was the most common complication of the procedure in 6 patients (19.4 %). Angioplasty in 5 of these patients was done by the open technique. Other complications included hematoma in 3 (9.7%) patients and one ca se (3%) of artery perforation. Among those who remained asymptomatic a t the end of the follow-up period the mean change in ABI was 0.625+/-0 .19, those who improved but remained symptomatic the mean ABI change w as 0.43+/-0.25 while those whose symptoms did not change or worsened t he mean ABI change was 0.12+/-0.13. The ABI change in the first two gr oups was significantly higher than the last one (p<0.006 and p<0.001 r espectively). There was no significant difference in the outcome of LA BA between stenosed and occluded vessels. Smoking was significantly hi gher in the symptomatic patients (7/20) compared to those who were asy mptomatic 5/12, p<0.02. Diabetes mellitus, cardiovascular disease and the preoperative ABI were not significant variables in the outcome of angioplasty, Conclusions. In conclusion, Nd Yag laser assisted angiopl asty is a safe procedure. It could relieve symptoms in 87.1% of cases. Change in the ABI and smoking are predictive of the success of the pr ocedure.