AUTHOR=Pu Hongji , Jiang Yihong , Wu Zhaoyu , Lei Jiahao , Hu Jiateng , Qiu Peng , Zhang Xing , Huang Qun , Lu Xinwu , Yin Minyi , Zhao Zhen 

TITLE=Endovascular Excimer Laser-Assisted Balloon Angioplasty for Infrapopliteal Arteries in Thromboangiitis Obliterans: A Treatment for Acute-Phase TAO

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.831340

DOI=10.3389/fcvm.2022.831340

ISSN=2297-055X

ABSTRACT=Background: Thromboangiitis obliterans (TAO, Buerger’s disease) is an inflammatory and obstructive vasculopathy, which leads to limb ischemic rest pain and ulcerations in the acute stage. Objectives: This study aimed to assess the feasibility of excimer laser-assisted balloon angioplasty (BA) for patients with acute infrapopliteal TAO. Method: This was a single-center retrospective cohort study. Two hundred and twenty patients with 210 target limbs between January 2012 and September 2021 were involved. Among them, 52 target limbs were received endovascular excimer laser-assisted balloon angioplasty from January 2017. The ankle brachial index (ABI), rest pain score, ulcer, Rutherford classification, and TASC II classification were assessed. The follow-up time was 6 months. Results: The technical success rate of laser + BA and BA group was 71.15% and 65.82% (p = 0.5021). After intervention, the ABI of two groups were 0.85 ± 0.20 and 0.77 ± 0.20 (p = 0.0419), and the rest pain score was 1.00 ± 1.43 and 1.71 ± 2.25 (p = 0.0449). During the 6 months follow-up, the ABI of two groups was 0.76 ± 0.17 and 0.75 ± 0.23 (p = 0.8539), the rest pain score was 1.43 ± 1.82 and 2.24 ± 2.06 (p = 0.0783), and the ulcer rate was 23.68% and 40.98% (p = 0.0867), respectively. The proportion of patients who were assessed as TASC II C/D or Rutherford 4-6 in laser +BA group was significantly lower than that in BA group, indicating that the former had better efficacy. The rate of critical limb ischemia and restenosis in the laser +BA group was lower than that in the BA group (47.36% vs. 67.22%; 21.05% vs. 34.43%) during follow-up. In the laser + BA group, the reintervention rate was lower than that in the BA group (2.70% vs. 8.20%, p = 0.0425). No serious adverse events occurred. Conclusion: Excimer laser debulking-assisted angioplasty is a feasible, effective and safe method to treat acute infrapopliteal TAO.