Laser Uses in Noncoronary Arterial Disease

Background: In the past decade, excimer laser angioplasty (ELA) has emerged in the field of peripheral artery disease (PAD). Laser indications now extend to off-label uses, such as in situ fenestration of aortic endograft. The aim of this study was to review the different therapeutics applications of lasers in arterial disease treatment. Methods: We reviewed the English-language literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We selected 106 relevant papers. We excluded unrelated papers (n = 67), letters and commentaries (n = 6), and review articles (n = 7), leaving 26 articles to form the basis of this review. Results: A total of 18 articles were included in the analysis of ELA applications in PAD. Nine articles were related to atherosclerotic plaques. With a mean follow-up of 15 ± 7 months, primary patency was 65% ± 20%. The mean distal embolism rate during the procedure was 5%. Eight more articles focused on in-stent restenosis. The mean technical success was 98%, and the rate of distal embolism during the procedure was 9%. With a mean follow-up of 10 ± 4 months, primary patency was 68% ± 18%. Eight articles described “off-label” excimer laser indications in endovascular therapy, including 5 papers regarding in situ fenestrations for complex aortic aneurysms. Conclusion: Laser atherectomy and laser-assisted techniques are an important part of a vascular surgeon and interventionalist's armamentarium.