Laser in infra-popliteal and popliteal stenosis (LIPS): retrospective review of laser-assisted balloon angioplasty versus balloon angioplasty alone for below knee peripheral arterial disease

Abstract

Despite the use of laser technology over the last decade, there are limited data to show its procedural and clinical success in infra-popliteal disease. We hypothesized that laser-assisted balloon angioplasty (LABA) is at least similar or better in procedural and peri-procedural outcomes compared to balloon angioplasty (BA) alone, despite adverse lesion characteristics prior to intervention. Retrospective chart and angiogram review of consecutive critical limb ischemia (CLI) patients who underwent endovascular revascularization in the popliteal or infra-popliteal vessels between 2007 and 2012 with LABA or BA alone. Data from 731 patients revealed that baseline demographics were similar in the LABA (n = 398) and BA group (n = 333) with minor exceptions. More patients in the LABA group had TASC-D lesions (92.5 vs. 66.7 %; P < 0.0001) and chronic total occlusions (CTOs) in both vessel 1 (86.4 vs. 49.5 %; P < 0.0001) and vessel 2 (78.6 vs. 47.8 %; P < 0.0001). Multivariate analysis performed using logistic regression after adjusting for confounding factors showed use of LABA was associated with a 7 times greater likelihood of achieving <50 % residual disease compared to BA alone (OR 7.59, P < 0.0001), and a 5 times greater likelihood of improvement in the infra-popliteal lesion severity score than balloon angioplasty alone (OR 4.77, p < 0.0001). LABA is significantly better at achieving angiographic success and improving lesion severity score in spite of adverse lesion characteristics (more TASC-D lesions and CTOs) compared with BA alone. Our findings suggest that the use of LABA is an endovascular approach that is at least as effective and safe or better compared to BA for the treatment of CLI from complex popliteal and infra-popliteal vascular disease.

Long‐term outcomes of patients with diabetes mellitus undergoing percutaneous intervention for popliteal and infrapopliteal peripheral arterial disease

“…The end score is added up from four categories. Patient could have a minimum score of 0 to max score of 12 (Supporting Information Table 5) .…”

Laser in infrapopliteal and popliteal stenosis 2 study (LIPS2): Long‐term outcomes of laser‐assisted balloon angioplasty versus balloon angioplasty for below knee peripheral arterial disease

“…While LABA was associated with better procedural angiographic success and improving lesion severity score, despite having worse baseline angiographic characteristics (more chronic total occlusion and TASC C/D lesions) as reported before [5], this was associated with similar rate of major ipsilateral limb amputations, any ipsilateral (major and/or minor) amputations and repeat revascularizations compared with BA at median follow up time of 36 months. Periprocedural complication rates were similar, except for less distal embolization in LABA.…”

“…Despite having more TASC-D lesions in LABA group (92.4 vs. 66.5%, P < 0.0001), the rate of angiographic success (residual stenosis <50%, 97.7 vs. 89.2%, P < 0.001) were higher in LABA compared to BA. Complication rates during index procedure were similar except for lower incidence of distal embolization in LABA group (0.5 vs. 3.3%, P = 0.004) [5]. …”

“…No data exist from large-scale randomize clinical trial on the efficacy of LABA compared with other revascularization strategies (BA with or without stenting or peripheral bypass surgery). We have previously reported the findings of nonrandomized retrospective Laser in Infrapopliteal and Popliteal Stenosis (LIPS) study that compared LABA with BA alone for popliteal and infrapopliteal PAD, and showed that the use of LABA was safe and resulted in better procedural success compared to BA for treatment of CLI from complex popliteal and infrapopliteal vascular disease [5]. The current study provided further insights into the long-term outcomes of these patients and suggested that despite higher initial angiographic success rate in LABA group, long-term limb loss was similar in the two groups.…”

Infrapopliteal Artery Occlusive Disease: An Overview of Vessel Preparation and Treatment Options

“…Finally, in 2013 the Laser in infra-popliteal and popliteal stenosis (LIPS) retrospective review, analyzed LA vs PTA for IPOD. The study showed that LA plus PTA had a 5 times greater likelihood of improvement in the IPA lesion severity score compared to PTA alone [ 41 ].…”