[Application and value of excimer laser ablation in the treatment of lower limb atherosclerotic obliterans].

Objective

To evaluate the results of excimer laser ablation (ELA) in the treatment of lower limb atherosclerotic obliterans (ASO).

Methods

From June 2019 to March 2020, patients who underwent ELA combined with drug-coated balloon (DCB) for lower limb atherosclerotic obliterans (ASO) were enrolled. Demographics, lesion characteristics, procedure-related outcomes and complications were collected and analyzed.

Results

Thirty patients were enrolled, including 21 males and 9 females. The mean age was (76.5±10.5) years. The mean lesion length was (11.7±6.4) cm. A total of 41 lesions, including in-stent restenosis (ISR) in 12 (29.3%), chronic totally occlusion (CTO) at initial treatment in 24 (58.5%), and severe stenosis in 5 (12.2%) patients. Sixteen (51.6%) patients were classified as Peripheral Arterial Calcium Scoring System (PACSS) category 4. The technical success rate was 93.5%. Incidence of distal embolization and bailout stenting was 12.9% and 6.5%, respectively. The mean follow-up time was (6.6±3.0) months. Ankle-brachial index (ABI) was significantly increased from 0.43(0.32,0.55) preoperatively to 0.91(0.87,1.01) postoperatively (Z=-5.43, P<0.01) and 0.82(0.73,1.02) (Z=-3.99, P<0.01) three months after surgery. The 3-month major-amputation free survival rate was 96.7%, primary patency rate was 100%, the target lesion reintervention (TLR) rate was 0 and ulcer healing rate was 76.9%.

Conclusion

Debulking of ELA is feasible and effective for both ISR and CTO at initial treatment, providing a new option for DCB preparation and reducing stent implantation.