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Therapy of Peripheral Arterial Disease: Laser-Assisted Angioplasty Combined with Intravascular Endoprosthetic Stents

Percutaneous transluminal laser-assisted angioplasty (PTLA) was combined with percutaneous implantation of vascular endoprostheses to reduce the reoc clusion rate after recanalization of iliac and femoropopliteal occlusions. PTLA (laser recanalization and following balloon dilation) was performed in 56 complete occlusions of iliac (n=9), femoral (n=31), and popliteal (n=16) arteries. Success or failure was defined by clinical criteria (Fontaine's classifica tion), ankle-arm Doppler systolic pressure index, and (if necessary) arteriog raphy. Cumulative long-term patency (mean follow-up time sixteen months) was estimated by the Kaplan-Meier method. The success was also analyzed in corre lation with a couple of variables (localization, length of occlusion, vessel runoff, and the medical treatment). The initial success rate of PTLA was 83.9%. Reocclusions (4 immediate and 5 at follow-up) occurred only in patients with initially insufficient morphologic result after balloon dilation. In 17 of such cases with residual stenosis after PTLA, stents were implanted. Stent implantation was completed in 88.2%. The overall cumulative success was 68.4%. No difference was observed in this study between the long-term patency rates of treated iliac and femoropopliteal vessels. The combination of laser recanalization and implantation of vascular stents is a promising method in the management of peripheral arterial occlusive dis ease. It can prevent reocclusions after PTLA and avoids bypass surgery.