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Although the use of stents for treatment of limb-ischemia for femoro-popliteal lesions is related to improvement of clinical outcomes, the rate of in-stent re-stenosis (ISR) can be high prevalent. Other than treating this complication with percutaneous balloon angioplasty (PTA) the associated use of laser has been demonstrated to add clinical improvement by dissolving the occlusion. We sought to evaluate the safety and efficacy of laser with PTA for ISR of femoropopliteal arteries.
We systematically searched Pub Med Cochrane and Embase for all clinical studies that described the use of laser with PTA for ISR of femoro-popliteal lesions. Primary outcome was primary patency. Secondary outcomes were survival, freedom from target lesion revascularization (TLR) and freedom from amputation. We reported the prevalence of events. We compared it to entire historical data.
A total of four studies (2 RCTs and 2 observationals) provided a total of 289 patients. Primary patency was presented in 60 % of patients on 6-12 months follow up. 89% of these patients survived, 99% remained free from amputation, and 78% remained free from TLR. Compared to historical data primary patency, freedom from amputation and from TLR were less in the laser+PTA group.
The use of laser therapy for treatment of femoro-popliteal ISR is safe and feasible. Compared to historical data it is considered to be superior.