Initial trial of argon ion laser endarterectomy for peripheral vascular disease
J. Eugene, R. A. Ott, Y. Baribeau, S. J. McColgan, M. W. Berns and G. R. Mason
Department of Surgery, University of California, Irvine.
In the initial of open laser endarterectomy, 16 patients underwent 18
reconstructions for claudication (13 patients), rest pain (3 patients), and
gangrene (2 patients). The mean (+/- SD) preoperative ankle arm index was
0.53 +/- 0.18. The laser endarterectomies were aorto-bi-iliac (1 patient),
iliac (1 patient), superficial femoral (7 patients), profunda femoral (7
patients), and popliteal-posterior tibial (2 patients). All operations
included surgical exposure, vascular control, administration of heparin,
and an arteriotomy. Atheromas were dissected from arteries with argon ion
laser radiation (power, 1.0 W). End points were welded with laser light.
Arteries were closed primarily. The laser endarterectomies were 6 to 60 cm
long and required 168 J to 2447.5 J. All patients had symptomatic relief,
with a postoperative ankle arm index of 0.97 +/- 0.10. There were no
arterial perforations from laser radiation. Surgical complications included
early thrombosis requiring thrombectomy (3 patients) and hematoma requiring
evacuation (1 patient). The laser endarterectomies have an 88% patency at 1
year. Open endarterectomy can be performed with laser radiation. A larger
clinical trial is necessary to define the indications for laser
endarterectomy in peripheral vascular disease.