Poor outcomes with cryoplasty for lower extremity arterial occlusive disease

Schmieder, Gregory C.; Carroll, Megan; Panneton, Jean M.

doi:10.1016/j.jvs.2010.03.012

Cited by 9 publications

(2 citation statements)

References 13 publications

(21 reference statements)

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“…The rates of freedom from major amputation were 93.4% at six months and 85.2% at 12 months with the lowest rate in those with Rutherford category 4 ischemia (0%) and highest in those with Rutherford category 6 ischemia (40%). More recently, another large series from Schmieder et al 13 reported on 88 cryoplasty procedures performed in 71 patients included 35 procedures for the treatment of in-stent stenosis. They had 71% initial technical success in these procedures.…”

Section: Discussionmentioning

confidence: 99%

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Cryoplasty offers no advantage over standard balloon angioplasty for the treatment of in-stent stenosis

et al. 2013

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In-stent restenosis is the primary failure mode of endovascular treatment of occlusive disease in the femeropopliteal segment. Cryoplasty has been proposed to reduce intimal hyperplasia through induction of apoptosis. We sought to evaluate the efficacy of cryoplasty for treatment of in-stent restenosis compared to conventional balloon angioplasty (CBA). After IRB approval, a retrospective record review was performed of reinterventions for in-stent restenosis by a single vascular surgery group at a university hospital. Reinterventions involving cryoplasty and CBA were evaluated at 1, 3, 6 and 12 months after intervention with duplex imaging to identify significant recurrent stenosis utilizing established velocity criteria. Data collected included basic demographic information and comorbidities as well as time to restenosis. Statistical analysis was performed using Kaplan–Meier survival curves with the log rank test, Wilcoxon rank test, and Cox proportional hazards models. From December 2004 to November 2007, 76 reinterventions were performed using CBA (n = 39) or cryoplasty (n = 37) for in-stent restenosis without placement of additional stents. Periprocedural technical success (>30% residual stenosis) was 100% for both groups, with no complications. The two cohorts were statistically similar in mean age, gender, comorbidities, tobacco use and use of statins, aspirin and Plavix. However, the mean lesion length was significantly longer in the cryoplasty cohort (CBA: 140.9 mm, Cyro: 191.7 mm; P = 0.032). The mean time to recurrent stenosis or need for additional secondary intervention was significantly shorter for the cyroplasty cohort than for the CBA, 4.09 and 10.79 months, respectively (P = .0001). Recurrent stenosis-free survival was significantly lower in the cyroplasty cohort at 3 months (CBA: 96.9%, Cyro: 88.9%) and 6 months (CBA: 84.0%, Cyro: 43.8%; P = .0089). Cyroplasty as a modality for treatment of in-stent stenosis in the femoropopliteal segment offers no benefit over CBA.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, cryoplasty is an expensive modality associated with a nearly $1851.50 upcharge when compared with CBA, 13 thus making the application of this technology difficult to justify without evidence of clinical success.…”

Section: Discussionmentioning

confidence: 99%