Excimer laser-assisted angioplasty for infrainguinal artery disease.

After nearly 2 decades of research and experimentation with laser-assisted angioplasty, the xenon-hydrogen chloride excimer laser emerged as the laser device best suited for the treatment of peripheral artery disease. Emitting light at a wavelength of 308 nm, this laser utilizes a nonthermal mechanism of action to ablate plaque and thrombus in powerful discrete pulses. The excimer laser is particularly useful for the treatment of complex conditions, such as long chronic occlusions in the superficial femoral artery and in those patients with below-the-knee disease and critical limb ischemia who may not be good candidates for bypass surgery. A number of investigators have noted that the excimer laser will often uncover distinct, more focal lesions in what appears to be an extensive and complex occlusion, potentially simplifying treatment of these segments. The Laser Angioplasty for Critical Limb Ischemia phase 2 trial, a prospective registry of 145 patients at 11 US and 3 German sites, achieved good procedural success (86%) and an excellent 6-month limb salvage rate (93%). A new specialized deflecting sheath designed to direct excimer ablation in blockages of the larger main arteries above the knee has produced clinical improvement in a single-center feasibility study and a 16-center prospective registry. Less promising results were reported in a single-center real-world retrospective registry, warranting careful case selection with this device for patients with diabetes and renal failure.