Excimer laser atherectomy combined with drug-coated balloon angioplasty for the treatment of femoropopliteal arteriosclerosis obliterans

Ann R Coll Surg Engl. 2022 Nov;104(9):667-672. doi: 10.1308/rcsann.2021.0335. Epub 2022 Apr 21.


Introduction: It has been reported that excimer laser atherectomy combined with a drug-coated balloon (ELA+DCB) can achieve better results than simple balloon angioplasty, especially for the treatment of femoropopliteal in-stent restenosis. However, reports on the application of ELA+DCB in China for femoropopliteal arteriosclerosis obliterans are lacking. This study focuses on analysing the effectiveness and safety of ELA+DCB.

Methods: This was a single-centre retrospective study that enrolled patients from November 2016 to January 2019 who had femoropopliteal arteriosclerosis obliterans treated by ELA+DCB. Preoperative demographics, operative details and postoperative follow-up outcomes were analysed statistically.

Results: There were 43 patients with an average patient age of 68.0±8.6 years; 79.1% were male. In 30 cases, the lesions were de novo and the others were in-stent restenosis (ISR). During the procedure, flow-limiting dissection (48.8%) was the main adverse event and there were 17 bailout stent implantations due to dissection. Mean (±sd) ankle-brachial index (ABI) in the patients was 0.42±0.31 before the operation and 0.83±0.13 before discharge. The mean (±sd) follow-up time was 29.35±9.71 months. The primary patency rate was 66.8%, 64.3% and 60.9% at 12, 24 and 36 months. Freedom from target lesion revascularisation (TLR) was 85.7%, 80.7% and 75.3% at 12, 24 and 36 months. Rutherford categories also greatly improved during follow-up. Overall mortality was 6.9% (3/48), and no deaths were related to the intervention.

Conclusion: The use of ELA+DCB had good clinical benefit for femoropopliteal arteriosclerosis obliterans, which had good primary patency and freedom from TLR, although intraoperative complications still required attention. Multicentre randomised controlled trials with long-term follow-up are needed.

Keywords: Drug-coated balloon; Excimer laser atherectomy; Femoropopliteal arteriosclerosis obliterans.

MeSH terms

  • Aged
  • Angioplasty, Balloon* / adverse effects
  • Arteriosclerosis Obliterans* / etiology
  • Arteriosclerosis Obliterans* / surgery
  • Atherectomy / adverse effects
  • Atherectomy / methods
  • Coated Materials, Biocompatible
  • Constriction, Pathologic / etiology
  • Coronary Restenosis* / etiology
  • Female
  • Femoral Artery / surgery
  • Humans
  • Lasers, Excimer / therapeutic use
  • Male
  • Middle Aged
  • Peripheral Arterial Disease* / surgery
  • Popliteal Artery / surgery
  • Retrospective Studies
  • Treatment Outcome
  • Vascular Patency


  • Coated Materials, Biocompatible