Effect of Limb Salvage by Excimer Laser Debulking plus Low-pressure Balloon Inflation Without Stent Deployment in Patients with Infrapopliteal Vessel Disease v3

Abstract

BACKGROUND: Patients with critical limb ischemia (CLI) often exhibit long, diffuse, totally occluded, and heavily calcified infrapopliteal (IP) lesions. Peripheral excimer laser atherectomy (PELA) has been proposed to increase the treatment success for complex IP lesions. This study evaluated the limb salvage after PELA plus low-pressure balloon inflation (LPBI) without stent deployment in CLI patients with severe IP disease. METHODS: We retrospectively evaluated for 82 consecutive patients with 125 IP vessels who underwent PELA plus LPBI in a 4-year period. Technical success was defined as IP straight-line flow being achieved below the malleolus. The binary logistic regression was performed to find factors associated with 6-month limb salvage RESULTS: A total of 113 vessels (90.4%) were totally occluded, and none of the patients received a stent. Twenty-one percentage of the patients were octogenarians, and 84% of the patients were Rutherford-Becker class 5 and 6. The technical success rate was 72% and 6-month limb salvage rate was 77%. Binary logistic regression showed age, smoking history and technical success were independent predictors for 6-month limb salvage. CONCLUSIONS: PELA plus LPBI without stent deployment is a reasonable option for treating complex IP lesions in patients with CLI. Technical success plays an important role in 6-month limb salvage