These combined results indicate that transmyocardial laser revascularization provides angina relief, decreases hospital admissions, and improves perfusion in patients with severe coronary artery disease.
Background-Although transmyocardial laser revascularization (TMR) has provided symptomatic relief of angina over the short term, the long-term efficacy of the procedure is unknown. Angina symptoms as assessed independently by angina class and the Seattle Angina Questionnaire (SAQ) were prospectively collected up to 7 years after TMR. Methods-Seventy-eight patients with severe angina not amenable to conventional revascularization were treated with a CO 2 laser. Their mean age was 61Ϯ10 years at the time of treatment. Preoperatively, 66% had unstable angina, 73% had had Ն1 myocardial infarction, 93% had undergone Ն1 CABG, 42% had Ն1 PTCA, 76% were in angina class IV, and 24% were in angina class III. Their average pre-TMR angina class was 3.7Ϯ0.4. Results-After an average of 5 years (and up to 7 years) of follow-up, the average angina class was significantly improved to 1.6Ϯ1 (Pϭ0.0001). This was unchanged from the 1.5Ϯ1 average angina class at 1 year postoperatively (PϭNS).There was a marked redistribution according to angina class, with 81% of the patients in class II or better, and 17% of the patients had no angina 5 years after TMR. A decrease of Ն2 angina classes was considered significant, and by this criterion, 68% of the patients had successful long-term angina relief. The angina class results were further confirmed with the SAQ; 5-year SAQ scores revealed an average improvement of 170% over the baseline results. Conclusions-The long-term efficacy of TMR persists for Ն5 years. TMR with CO 2 laser as sole therapy for severe disabling angina provides significant long-term angina relief.
ILIOFEMORAL thrombectomy for acute deep vein thrombosis was described by Leriche in 1948 5 and became known in America through Mahorner et al. in 1957.6 Since then the operation has been variably accepted by American surgeons, and a series of 45 cases was reported from the University of Louisville in 1963 by Haller and Abrams.2 The advantages of the operative procedure over elevation and heparin therapy were stated to be immediate relief of compromised venous drainage of the lower extremity, lessened morbidity, venous valve preservation, and prevention of the postphlebitic syndrome. Since all of the original Louisville group were operated on at least 5 years ago, an assessment of their status evaluates the validity of these assumptions.
MethodThe operative technic has been previously described.2 Hospital and clinical records of 39 of the original 45 patients were still available. Special attention was directed to the 34 patients who underwent operation less than 10 days after the onset of symptoms, since most investigators have agreed that this type of patient most likely benefits from the procedure. Hospital records determined the volume of blood trans-
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