Clinical utility of laser recanalization in occluded peripheral arteries

Article Abstract:

A number of new techniques have been reported over the past few years that purport to treat narrowed and clogged veins and arteries. They all involve devices that work within vessels to clear fatty deposits that clog them. The standard treatment of this kind is balloon angioplasty, which involves inflating a balloon at the end of a catheter that is inserted in a vessel to open it up. One of the most highly touted challengers to this technique is the use of lasers to open these vessels. Initial experimentation with lasers was discouraging. Little of the accumulated fatty plaque was actually removed and damage to the vessels was high. The techniques using lasers have been refined by varying energy sources and delivery systems. Four major systems have been developed for use in treating occluded (blocked) arteries in the leg. They work by initially opening the blockage so that other treatments such as angioplasty can be used for further opening. The Trimedyne thermal system uses laser energy to heat blunt metal probes, which are used to make an opening in the blockage. Balloon angioplasty can then be used. Results of research on the effectiveness of this approach are promising but not conclusive. The LASTAC system uses a laser to heat the fiberoptic tip that precedes a balloon catheter. Limited research has shown success with this technique. The MCM system uses two lasers with a feedback system to avoid damaging vessel walls. This technique is also promising, but it is complicated and expensive. The SLT sapphire probe system works by defocusing laser energy through a sapphire crystal in a metal tip, which focuses light rather than heat on the plaque. A large study of this technique has found highly favorable results and is reported in the February 1991 issue of Radiology. Nonlaser angioplasty techniques have also been improved, bringing into question the need for laser techniques, which are both complicated and expensive. The end result may be that laser systems will be reserved for patients who cannot be successfully treated by more conventional methods. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Innovations, Atherosclerosis, Arterial occlusions, Arterial occlusive diseases, Laser angioplasty

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Controversies in peripheral vascular intervention

Article Abstract:

Most of the diagnostic and therapeutic techniques now used to examine and treat peripheral vascular disease, that is, disease of the blood vessels that are not part of the cardiopulmonary system, were developed and initially used primarily by radiologists. This was also true in the case of coronary vascular disease, although cardiologists themselves now perform most of the diagnostic tests and treatments for it. The radiology profession lost control of this area because it failed to recognize the importance of the area and it failed to provide specialized training in the area for radiologists. The profession is now confronted with a similar situation regarding peripheral vascular disease. Increasingly, physicians from specialties other than radiology are performing the diagnostic and therapeutic interventions for peripheral vascular disease. Surveys of cardiologists and vascular surgeons indicate they are increasingly becoming involved in these procedures because there is no radiologist specifically trained in the area on their staffs. In situations where there is a trained interventional radiologist, cardiologists and vascular surgeons appear very willing to work with the radiologist rather than competing with him or her. Obviously, the radiology profession must encourage specialized training in this area. Increasing patient contact, from initial intake through treatment, would increase patient awareness of and confidence in the role of the interventional radiologist. This combination of increasing specialized training in interventional radiology and increasing the interventional radiologist's contact with patients should lead to a cooperative rather than a competitive relationship with other physicians when treating patients with peripheral vascular disease, and will maintain radiology's presence in an area it helped to develop. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medicine, Practice, Training, Peripheral vascular diseases, Medical specialties, Radiologists, Radiology

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