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1	Emerging Excimer Laser Therapy in CLI Broadening the Scope of Treatment Giancarlo Biamino, MD and Andrej Schmidt, MD Department of Clinical and Interventional Angiology University of Leipzig – Heartcenter
2	Characteristics of Patients with Critical Limb Ischemia
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5	Comparison of the Different Tools for CLI
6	Excimer Laser: Athermic photoablation process of atherosclerotic material Pulsed XeCl- Laser (Spectranetics CV300) Wavelength 308 nm Pulsduration 120 ns Fluence 30-50 mJ/mm² Repetition Rate 25-50 Hz
7	EXCIMER L.A.S.E.R Powerful Tool for „COOL“debulking Effective endovascular „ATHERECTOMY“ Facilitating Balloon Dilatation Reducing the Need for Stenting
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13	Laser-Angioplasty of SFA-Occlusions Patients n = 318 Number of lesions n = 411 Occlusion-length 19.4 ± 6.0 cm Successful laser-recanalisation 90.5%
14	Clinical Result
15	Problem of SFA-Angioplasty
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17	Step by Step Technique Lasering the first millimeter Probing with a 0,018“ / 0,035 inch guide wire to penetrate the occlusion a few mm at a time, followed by laser ablation when subintimal tracking suspected, withdraw and redirect the wire check catheter alignment with road mapping Cross the final two centimeters of the occlusion with the guide wire prior to laser ablation
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19	Highly calcified occlusion right SFA
20	Occlusion of the distal left SFA
21	Balloon „sealing“ after SFA-Perforation
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29	8F Turbo-Booster for native SFA
30	8F Turbo-Booster for native SFA
31	8F Turbo-Booster for native SFA
32	8F Turbo-Booster for native SFA
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36	Stent X 6 Months after Pop-Recanalization
37	Thrombus-Containing Popliteal Occlusion
38	Thrombus-Containing Popliteal Occlusion
39	Thrombus-Containing Popliteal Occlusion
40	Thrombus-Containing Popliteal Occlusion
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54	LACI-Trial - 6-Month Results
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62	Conclusion Lasering is highly successful in a wide variety of pathologies Long and diffuse lesions Thrombus-containing lesions Calcified lesions Very distal lesions Multilevel disease
63	Conclusion The Excimer-laser is broadening tremendously the armamentarium for endovascular treatment of CLI-patients. The success of laser-therapy is highly dependent on the operator-experience with this technique.
64	Conclusion Which catheter-size for which lesion Which energy and repetition-rate for which lesion How many passes Step-by-step technique or first wire-passage Additional treatment or not