Peripheral Artery Disease (PAD) is highly prevalent, yet substantially under-diagnosed. It carries significant risk of morbidity and mortality for those who are not identified and treated early. Progression of PAD may look like the following:

PAD Treatment Goals

  • Prevent limb loss
  • Relieve symptoms (rest or activity)
  • Improve circulatory capacity
  • Reduce cardiovascular risks

Why Atherectomy?

Treating Peripheral Artery Disease (PAD) presents unique challenges. The diffuse nature of the disease and its many complexities have generated the evolution of many new technologies and approaches toward safer and more effective solutions for treating PAD.

Excimer Laser Atherectomy

The excimer laser atherectomy procedure uses a flexible fiberoptic catheter to deliver bursts of UV energy in short pulse durations. The advantage of UV light is its short penetration depth (0 um) and its ability to break molecular bonds directly by a photochemical rather than thermal process. The excimer laser catheter removes a tissue layer of about 10 um with each pulse of energy. Tissue is ablated only on contact, with no consequent rise in temperature to surrounding tissue. Additionally, UV light has the ability to ablate thrombus and to inhibit platelet aggregation.1

Laser-assisted angioplasty can be used across a wide range of complex anatomic lesions with a high technical success rate, lower cost, and lower risk than surgical revascularization.2 Potential advantages of laser atherectomy include:

  • Ability to treat long occlusions and complex disease effectively, providing a better angiographic result with less distal embolization and less need for stenting.1
  • Facilitate effective crossing of chronic total occlusions using a controlled “step-by-step” technique.1
  • Treatment of complex occlusive disease in patients presenting with Critical Limb Ischemia (CLI). Laser atherectomy may be an option for patients that are a high surgical risk because of poor underlying physiology or complex lesion anatomy. Short-term outcomes from multicenter trials cite patency rates as high as 93% at 6 months in patients with Critical Limb Ischemia (CLI).2

What to Look For

Because many people are asymptomatic, Peripheral Artery Disease (PAD) goes largely undiagnosed. However, early diagnosis and treatment can reduce the risk of serious cardiovascular events, and even death. Identification of patients at-risk for PAD and initiation of secondary prevention may provide opportunities for improved outcomes.

PAD Risk Factors

  • Age: PAD is most common in the elderly and incidence increases with age3
  • Smoking: Smoking increases the risk of developing PAD by 4X4
  • Diabetes: Diabetic patients have a 2-4X risk of PAD3
  • Hypertension
  • ABI: Less than 0.9

 

In-Clinic Screening Check List

The first step to identifying patients with PAD is a vascular physical examination which would include:

Patient History

Physical Examination to detect:

  • Decreased or absent pulses
  • Presence of Bruits
  • Muscle atrophy
  • Hair loss
  • Pallor or cyanosis
  • Cool extremities
  • Ulcers or gangrene

Diagnostic Tests, such as:

  • Ankle Brachial Index (ABI)
  • Stress ABI (>25% decrease in ABIs with exercise)
  • Duplex ultrasound
  • CT angiogram
  • MRA (magnetic resonance angiography)
  • Angiography (gold standard for diagnosis and treatment)

 

 

References

1. Lawrence JB, Prevosti LG, Kramer WS, Smith PD, Bonner RF, Lu DY, Leon MB. Pulsed laser and thermal ablation of atherosclerotic plaque: morphometrically defined surface thrombogenicity in studies using an annular perfusion chamber. J Am Coll Cardiol. 1992;19:1091–1100.

2. Laird JR, Zeller T, Gray BH, Scheinert D, Vranic M, Reiser C, et al. Limb salvage following laser-assisted angioplasty for critical limb ischemia: results of the LACI multicenter trial. J Endovasc Ther 2006;13:1-11.

3. Heuser, R. (2008). Textbook of Peripheral Vascular Interventions. United Kingdom: Informa healthcare

4. (2011) http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Your-Risk-for-PAD_UCM_301304_Article.jsp