Current status of laser angioplasty.

Laser energy transmitted through fiberoptic systems can recanalize totally occluded peripheral arteries and improve extremity perfusion in selected patients with peripheral vascular disease. Such a technique is obviously appealing in that it (1) reduces the morbidity currently associated with the surgical treatment of symptomatic peripheral atherosclerosis, and (2) allows treatment of patients currently excluded from therapy by the presence of other severe medical problems or relatively mild symptoms. Unfortunately, current delivery systems allow recanalization of only a small channel by laser energy alone, and channel enlargement using balloon dilation is usually required. Clinical trials of laser angioplasty (laser-assisted balloon angioplasty) have shown acceptable results in the treatment of stenosis or short occlusions in the iliac and superficial femoral arteries, but results in patients with long occlusions or disease below the knee remain well below the results achieved by standard surgical therapy. Thus the impact of laser angioplasty on the treatment of peripheral vascular disease is limited at present and much work remains to be done to further develop this exciting new therapy for the treatment of peripheral vascular disease.