Skip to main content
SpringerLink
Log in

Laser Revascularization for Critical Limb Ischemia

  • Chapter
Lasers in Cardiovascular Interventions

  • 729 Accesses

Abstract

Critical limb ischemia is associated with progressive multi-level lower extremity atherosclerosis and poor long term amputation and mortality rates. In additional to medical therapy, adjunctive endovascular intervention remains an important modality to maintain arterial patency to allow for adequate tissue healing leading to limb salvage and improving overall mortality. Laser atherectomy holds particular primes for challenging femoropopliteal and infrapopliteal lesions – for both de novo and in-stent restenosis. The current chapter delineates the technical aspects of laser atherectomy for treatment of complex lower extremity lesions and to review the clinical literature supporting the use of laser atherectomy in the treatment of critical limb ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ouriel K. Peripheral arterial disease. Lancet. 2001;358(9289):1257–64.

    Article  CAS  PubMed  Google Scholar 

  2. Norgren L, Hiatt WR, Dormandy MR, Nehler KA, Fowkes FGR. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(1):S5A–67.

    Article  Google Scholar 

  3. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(1 Pt 2):S1–296.

    CAS  PubMed  Google Scholar 

  4. Matsi PJ, Manninen HI, Suhonen MT, Pirinen AE, Soimakallio S. Chronic critical lower-limb ischemia: prospective trial of angioplasty with 1–36 months follow-up. Radiology. 1993;188(2):381–7.

    Article  CAS  PubMed  Google Scholar 

  5. Parsons RE, Suggs WD, Lee JJ, Sanchez LA, Lyon RT, Veith FJ. Percutaneous transluminal angioplasty for the treatment of limb threatening ischemia: do the results justify an attempt before bypass grafting? J Vasc Surg. 1998;28(6):1066–71.

    Article  CAS  PubMed  Google Scholar 

  6. Rogers JH, Laird JR. Overview of new technologies for lower extremity revascularization. Circulation. 2007;116(18):2072–85.

    Article  PubMed  Google Scholar 

  7. Wollenek G, Laufer G. Comparative study of different laser systems with special regard to angioplasty. Thorac Cardiovasc Surg. 1988;36 Suppl 2:126–32.

    Article  CAS  PubMed  Google Scholar 

  8. Scheinert D, Laird Jr JR, Schroder M, Steinkamp H, Balzer JO, Biamino G. Excimer laser-assisted recanalization of long, chronic superficial femoral artery occlusions. J Endovasc Ther. 2001;8(2):156–66.

    Article  CAS  PubMed  Google Scholar 

  9. Laird Jr JR, Reiser C, Biamino G, Zeller T. Excimer laser assisted angioplasty for the treatment of critical limb ischemia. J Cardiovasc Surg (Torino). 2004;45(3):239–48.

    Google Scholar 

  10. Laird JR. Peripheral excimer laser angioplasty (PELA) trial results. Presented at late breaking clinical trials. Transcatheter cardiovascular therapeutics (TCT) annual meeting, 24–28 Sept 2002, Washington, DC.

    Google Scholar 

  11. Siracuse JJ, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Chaikof EL, Nedeau AE, Schermerhorn ML. Results for primary bypass versus primary angioplasty/stent for intermittent claudication due to superficial femoral artery occlusive disease. J Vasc Surg. 2012;55(4):1001–7.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Gray BH, Laird JR, Ansel GM, Shuck JW. Complex endovascular treatment for critical limb ischemia in poor surgical candidates: a pilot study. J Endovasc Ther. 2002;9(5):599–604.

    Article  PubMed  Google Scholar 

  13. Laird JR, Zeller T, Gray BH, Scheinert D, Vranic M, Reiser C, Biamino G, Investigators L. Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial. J Endovasc Ther. 2006;13(1):1–11.

    Article  PubMed  Google Scholar 

  14. Bosiers M, Peeters P, Elst FV, Vermassen F, Maleux G, Fourneau I, Massin H. Excimer laser assisted angioplasty for critical limb ischemia: results of the LACI Belgium Study. Eur J Vasc Endovasc Surg. 2005;29(6):613–9.

    Article  CAS  PubMed  Google Scholar 

  15. Stoner MC, De Freitas DJ, Phade SV, Parker FM, Bogey WM, Powell S. Mid-term results with laser atherectomy in the treatment of infrainguinal occlusive disease. J Vasc Surg. 2007;46(2):289–95.

    Article  PubMed  Google Scholar 

  16. Serino F, Cao Y, Renzi C, Mascellari L, Toscanella F, Raskovic D, Tempesta P, Bandiera G, Santini A. Excimer laser ablation in the treatment of total chronic obstructions in critical limb ischaemia in diabetic patients. Sustained efficacy of plaque recanalisation in mid-term results. Eur J Vasc Endovasc Surg. 2010;39(2):234–8.

    Article  CAS  PubMed  Google Scholar 

  17. Laird Jr JR, Yeo KK, Rocha-Singh K, Das T, Joye J, Dippel E, Reddy B, Botti C, Jaff MR. Excimer laser with adjunctive balloon angioplasty and heparin-coated self-expanding stent grafts for the treatment of femoropopliteal artery in-stent restenosis: twelve-month results from the SALVAGE study. Catheter Cardiovasc Interv. 2012;80(5):852–9.

    Article  PubMed  Google Scholar 

  18. Sultan S, Tawfick W, Hynes N. Cool excimer laser-assisted angioplasty (CELA) and tibial balloon angioplasty (TBA) in management of infragenicular arterial occlusion in critical lower limb ischemia (CLI). Vasc Endovascular Surg. 2013;47(3):179–91.

    Article  PubMed  Google Scholar 

  19. Armstrong EJ, Singh S, Singh GD, Yeo KK, Ludder S, Westin G, Anderson D, Dawson DL, Pevec WC, Laird JR. Angiographic characteristics of femoropopliteal in-stent restenosis: association with long-term outcomes after endovascular intervention. Catheter Cardiovasc Interv. 2013;82(7):1168–74.

    Article  PubMed  Google Scholar 

  20. Schmidt A, Zeller T, Sievert H, Krankenberg H, Torsello G, Stark MA, Scheinert D. Photoablation using the turbo-booster and excimer laser for in-stent restenosis treatment: twelve-month results from the PATENT study. J Endovasc Ther. 2014;21:52–60.

    Article  PubMed  Google Scholar 

  21. Tosaka A, Soga Y, Iida O, Ishihara T, Hirano K, Suzuki K, Yokoi H, Nanto S, Nobuyoshi M. Classification and clinical impact of restenosis after femoropopliteal stenting. J Am Coll Cardiol. 2012;59(1):16–23.

    Article  PubMed  Google Scholar 

  22. Dippel EJ, Makam P, Kovach R, George JC, Patlola R, Metzger DC, Mena-Hurtado C, Beasley R, Soukas P, Colon-Hernandez PJ, et al. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv. 2015;8(1 Pt A):92–101.

    Article  PubMed  Google Scholar 

  23. Schillinger M, Sabeti S, Loewe C, Dick P, Amighi J, Mlekusch W, Schlager O, Cejna M, Lammer J, Minar E. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med. 2006;354(18):1879–88.

    Article  CAS  PubMed  Google Scholar 

  24. Scheinert D, Scheinert S, Sax J, Piorkowski C, Braunlich S, Ulrich M, Biamino G, Schmidt A. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol. 2005;45(2):312–5.

    Article  PubMed  Google Scholar 

  25. Tepe G, Zeller T, Albrecht T, Heller S, Schwarzwalder U, Beregi JP, Claussen CD, Oldenburg A, Scheller B, Speck U. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg. N Engl J Med. 2008;358(7):689–99.

    Article  CAS  PubMed  Google Scholar 

  26. Van Den Berg JC, Pedrotti M, Canevascini R, Chimchila Chevili S, Giovannacci L, Rosso R. Endovascular treatment of in-stent restenosis using excimer laser angioplasty and drug eluting balloons. J Cardiovasc Surg (Torino). 2012;53(2):215–22.

    Google Scholar 

  27. van den Berg JC. Commentary: laser debulking and drug-eluting balloons for in-stent restenosis: a light at the end of the tunnel? J Endovasc Ther. 2013;20(6):815–8.

    Article  PubMed  Google Scholar 

  28. Gandini R, Del Giudice C, Merolla S, Morosetti D, Pampana E, Simonetti G. Treatment of chronic SFA in-stent occlusion with combined laser atherectomy and drug-eluting balloon angioplasty in patients with critical limb ischemia: a single-center, prospective, randomized study. J Endovasc Ther. 2013;20(6):805–14.

    Article  PubMed  Google Scholar 

  29. Photoablative atherectomy followed by a paclitaxel-coated balloon to inhibit restenosis in instent femoro-popliteal obstructions (PHOTOPAC). Clinicaltrials.gov. Retrieved 30 Dec 2013 from http://clinicaltrials.gov/show/NCT01298947.

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA, 95817, USA

    Gagan D. Singh MD

  2. Division of Cardiovascular Medicine, Department of Internal Medicine, VA Eastern Colorado Healthcare System, 1055 Clermont Street, Denver, CO, 80220, USA

    Ehrin J. Armstrong MD, MSc, MAS

  3. Division of Cardiology, University of Colorado School of Medicine, 1055 Clermont Street, Denver, CO, 80220, USA

    Ehrin J. Armstrong MD, MSc, MAS

  4. Division of Cardiovascular Medicine, UC Davis Vascular Center, 4860 Y Street, Suite 3400, Sacramento, CA, 95817, USA

    John R. Laird MD (Professor of Medicine)

Authors
  1. Gagan D. Singh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ehrin J. Armstrong MD, MSc, MAS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John R. Laird MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John R. Laird MD .

Editor information

Editors and Affiliations

  1. Division of Cardiology, Charles George VA Medical Center, Asheville, North Carolina, USA

    On Topaz

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Singh, G.D., Armstrong, E.J., Laird, J.R. (2015). Laser Revascularization for Critical Limb Ischemia. In: Topaz, O. (eds) Lasers in Cardiovascular Interventions. Springer, London. https://doi.org/10.1007/978-1-4471-5220-0_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5220-0_10

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5219-4

  • Online ISBN: 978-1-4471-5220-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation