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

Abstract

Background Laser-assisted balloon angioplasty (LABA) has been shown to be more effective in achieving angiographic success for treatment for below knee peripheral artery disease (PAD) compared with balloon angioplasty alone(BA). However, long-term outcomes of LABA compared with BA for popliteal and infrapopliteal PAD are unknown. Methods We evaluated data on 726 patients undergoing LABA (n = 395) and BA (n = 331) for popliteal and infrapopliteal PAD retrospectively at a single center (2007–2012). Outcomes included long-term ipsilateral major limb amputation, revascularization and mortality (median follow-up = 36 months). Results Baseline features were similar in two groups with the exception of more TASC-D lesions (92.4 vs. 66.5%; P < 0.0001) and chronic total occlusions (86.4 vs. 49.5%; P < 0.0001) in LABA group. Angiographic success was higher in LABA compared with BA (97.7 vs. 89.2%; P < 0.0001). Ipsilateral major limb amputation (4.1 vs. 5.1%, P = 0.48) and repeat revascularization (25.1 vs. 23.3%, P = 0.47) were similar in LABA and BA patients despite unfavorable baseline angiographic characteristics in the former. Compared with BA, death was more frequently in LABA group (35.2 and 26.3%, P = 0.01), a reflection of higher comorbid conditions in this group (adjusted HR 1.05, 95% CI 0.79–1.39). Conclusion Despite worse baseline angiographic characteristics compared with BA, LABA was associated with higher angiographic success and similar ipsilateral major amputation, repeat revascularization, and long-term mortality. Future randomized clinical trial should evaluate the efficacy of LABA compared with BA (particularly drug-eluting) in improving limb salvage and reducing repeat revascularization in these high-risk PAD patients.

Network meta-analysis of balloon angioplasty, nondrug metal stent, drug-eluting balloon, and drug-eluting stent for treatment of infrapopliteal artery occlusive disease

“…In 2012, Shammas et al (30) performed an RCT with 50 patients and compared orbital atherectomy and BA; orbital atherectomy had high technical success (93.1%) and low TLR and death (6.7% and 0%). In 2015, Piyaskulkaew et al (31) retrospectively evaluated the data of 726 patients who underwent laser-assisted BA (n = 395) and BA (n=331) for popliteal and infrapopliteal peripheral artery diseases at a single center. An infrapopliteal artery lesion was found in 69.6% and 84% of the groups, respectively.…”

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

“…Data were collected retrospectively by reviewing the hospital's electronic medical records, which included patients' demographics, comorbidities, presenting symptoms, procedural details, and in‐hospital outcomes. The database was further augmented with collection of follow‐up data via telephone call and/or chart review to assess the long‐term outcomes, including mortality . All data were collected and entered in an Excel sheet.…”

Management of Critical Limb Ischemia

“…Long segment tibial atherectomy could cause embolization which decreases outflow and distal perfusion. One recent report showed greater acute success, but no difference in amputation, repeat revascularization or mortality with laser assisted versus conventional angioplasty 40 .…”