Reappraisal of Percutaneous Transluminal Laser Angioplasty.

Background and aims: We devised a technique to treat peripheral arterial disease (PAD) with laser, i.e. percutaneous transluminal laser angioplasty (PTLA). Considerable good results were obtained with PTLA, but it is apparently considered obsolete as a technique to treat occlusive arterial disease of peripheral arteries, perhaps because of the development and improvement of stents and the ease of their use compared to the somewhat intricate technique required for PTLA. Although the author admits the usefulness of stents, they are foreign to a human body. PTLA does not use a foreign body and contributes to the regeneration of the body's own artery.The aim of this article is to elucidate the beneficial effects of laser procedures in the treatment of PAD and to show the resulting good long-term patency, and to propose PTLA as an option to treat PAD.Some basic experiments and their results useful for PTLA will be introduced.

Materials and Methods: Ninety cases with occlusive peripheral arterial diseases were treated with PTLA during the period of March 1985 to March 1991.Our method of PTLA consists of occlusion of the proximal artery by a dilated balloon of a percutaneously introduced balloon catheter, and flushing with normal saline during irradiation by Nd:YAG laser.We used a ceramic tip attached to a laser catheter most of the time and a bare laser fiber under angioscopy or a bare laser fiber itself to treat smaller arteries in the legs.

Results: The initial success rate was 90%.The patency rates of PAD at 6 years are 91.4% (iliac artery) and 85.8% (femoropopliteal artery), and the patency rate of leg artery lesions is 100% at 5 years.Some clinical cases with long-term patency (6 and 30 years) will be introduced.Some fundamental experiments useful to the application of laser to atheroma or thrombi will be introduced.

Conclusions: PTLA could be a useful option to treat occlusive PAD, because it can produce longterm patency of natural arteries, provided a proper lesion was selected.