Laser atherectomy in the treatment of critical limb ischemia in diabetic patients

The aim of this prospective study was to evaluate the impact of the excimer laser technology as the first line endovascular treatment of critical limb ischemia (CLI) in diabetic patients. The protocol allowed the use of laser ablation of obstructive lesions when conventional endoluminal guidewire crossing of the plaque was unsuccessful. To extrapolate the data of patients with completed six month follow-up we restricted the observation to an extent of 15 months. In this time course, 67 diabetic patients with CLI were brought in to have "operative angiography" with the intention to treat with endovascular techniques: among the 67 cases, laser was used in 35 patients to treat 49 lesions. All lesions are type D in the TACS classification. Immediate clinical success, defined as restored direct arterial flow to the foot was 90%. Patency rates were assessed using the Kaplan-Meier survival curves. The patency rates (freedom from target lesion revascularization) were 94.7% at three months, 91.8% at six months, 85.0% at nine months, 85.0% at 12 months and 72.8% at 15 months. Limb salvage rate at 6 and 12 months were 100% and 94% (33 out of the 35 patients) respectively. Our study showed that the excimer laser assisted angioplasty is effective in limb salvage in CLI patients with diabetes, and that endoluminal driven atherectomy allows long-term success reducing the need of stents application in the lower limb arteries.