Laser Technique Prevents Diabetes Amputation

A laser technique that uses ultraviolet energy to restore blood flow to blocked arteries may help people with advanced diabetes avoid one of the most devastating complications of the disease — amputation. A study on the laser technique included mostly people with diabetes and those with high blood pressure at high risk for losing a limb because of severe diffuse atherosclerosis of the legs. These patients were considered poor candidates for bypass surgery — the gold standard treatment for prevention of limb loss.

Fewer than one in 10 ended up having a foot or leg removed within six months of having the laser procedure.
Washington Hospital Center interventional cardiologist John Laird, MD, who led the study, stated that without the laser intervention as many as half of the patients would probably have lost a limb during that time.

“This laser definitely seems to have a role to play in treating patients with the very worst disease who are facing amputations,” he says.

Diabetes-associated nerve and circulatory damage is the leading cause of lower limb amputation in the U.S., accounting for more than half of all foot and leg removals each year. According to the American Diabetes Association, 82,000 people lose a foot or leg to diabetes annually.

Saving limbs involves improving circulation, but many people with diabetes are poor candidates for surgery to bypass or improve blood flow because of many factors.

Conventional, heat-guided lasers were used briefly in the 1980s to burn away blockages. But the technique was quickly abandoned because the heat of the laser was too damaging to surrounding tissue.

The new device, known as the excimer laser, relies on flexible fiber optic catheters to deliver short bursts of ultraviolet energy. The laser is able to precisely target and vaporize blockages without damage to the surrounding artery. This unique feature helps reduce the potential for complications such as clot formations after the surgery. After the laser procedure, balloon angioplasty is performed on almost all patients to help open the once-blocked artery.

In the study, only nine of 119 patients at high risk for amputation ended up losing a limb within six months of having the laser procedure. About half of the patients also got stent implants, which act as scaffolding to prop damaged arteries open. Laird says results from balloon angioplasty alone tend to be poor in patients like the ones in the study who had severe artery disease with many blockages along the length of the artery.

Laird, J.R. Journal of Endovascular Therapy, 2006; vol 13: pp 1-11. John R. Laird, MD, Washington Hospital Center, Washington, D.C. Peter Sheehan, MD, NYU Medical Center Hospital for Joint Diseases Orthopaedic Institute Diabetes Foot and Ankle Center

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