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A Pulsed Dye laser together with specifically designed integral ball-tipped
optical fibres have been used for the primary recanalisation of femoropopliteal vascular disease in 25 limbs of 23 patients. All patients had
complete occlusions of the vessels ranging from 8-49cms in length (mean 22cms),
having presented with critical ischaemia (18) or severe claudication warranting
operative intervention (5). Pedal ulceration was present in 8 limbs and
digital gangrene in 4. The laser produced visible light at 480nm in lOOmJ/lus
pulses, at a frequency of 10-20Hz. The energy delivery device comprised a
smooth atraumatic ball-tip constructed from the glass of the optical fibre,
which was loaded retrogradely into a standard balloon angioplasty catheter. The
device was introduced through a common femoral artery cutdown. Angiographic
recanalisation was achieved in 22 of the 25 limbs with a mean energy of
280J(range 68-727J) and in each case the channel created by the laser fibre was
augmented by balloon angioplasty. Technical failure occurred in three cases,
caused by a wall dissection, persistent side-branch entry and incomplete lesion
penetration respectively. Eighteen of procedures (72%) were clinically
successful with marked symptomatic improvement.
Of the four angiographic successful but clinical failures, acute occlusion
within 48 hours occurred in 2 diabetic patients with very poor run-off and
distal gangrene. The third case failed acutely due to a technically inadequate
balloon dilatation and the fourth patient failed to improve symptomatically due
to widespread with segmental tibial vessel disease below a successful
recanalisation. Over a mean follow-up period of 7 months, three patients died
of myocardial infarction. Twelve of the 23 patients (52%) remain well with
patent vessels. These early results demonstrate the efficacy of pulsed dye
laser angioplasty using ball-tipped optical fibres.
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