Objective To explore the early clinical outcomes of excimer laser atherectomy combined with drug-coated balloon angioplasty in the treatment of diabetic infrapopliteal arterial lesions.

Methods From July 2021 to December 2022, 48 patients with diabetes infragenicular artery disease were retrospectively selected from the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Twenty four patients received excimer laser combined with DCB as the experimental group, and 24 patients received conventional balloon combined with DCB as the control group. The Rutherford classification was 2-5. Patients' surgical procedures, intraoperative complications, ankle-brachial index and improvement of symptoms were recorded.

Results The mean age of the experimental group was 72.1 years, with a total of 26 affected limbs, 49 vascular lesions and 34 chronic total occlusive lesions; the mean age of the control group was 74.1 years, with a total of 27 affected limbs, 41 vascular lesions and 32 chronic total occlusive lesions. The procedures were completed successfully in the experimental group without complications such as perforation or distal embolism. Remedial stents were implanted in two cases of flow-limiting entrapment of the peroneal artery and two cases of the anterior tibial artery after laser ablation treatment; the ankle-brachial index increased from 0.52 preoperatively to 0.89 postoperatively; resting pain was significantly reduced or disappeared in 19 affected limbs (19/20), and Ten (10/11) ulcers had healed, and only one patient was readmitted for intervention during follow-up without significant improvement in ulcer symptoms. In the control group, the ankle-brachial index increased from 0.63 preoperatively to 0.85 postoperatively; 16 affected limbs (16/19) showed a significant reduction or disappearance of resting pain, 4 (4/10) ulcers had healed, and 6 patients were readmitted to the hospital for intervention without significant improvement in ulcer symptoms during the follow-up period. The target vessel patency rate at 1 month after surgery was 95.8% and 75% in both groups, respectively. There was no amputation or death in any of the patients at follow-up.

Conclusions The use of excimer laser atherectomy combined with drug-coated balloons for the treatment of diabetic infrapopliteal arteriopathy has a high success rate with few complications, and the early clinical outcome is better than that of the balloon dilation group alone, but a large follow-up sample is still needed to observe the medium and long-term outcomes.