The Role for Cryoplasty in the Treatment of Infrainguinal Artery Disease:Case Studies

Abstract

Cryoplasty has been shown to be safe and effective for the treatment of atherosclerotic lesions in the peripheral vasculature and offers the promise of improving on the results of percutaneous transluminal angioplasty (PTA) by limiting dissection, vessel recoil, and restenosis. The PolarCath Peripheral Dilatation System utilizes nitrous oxide rather than the standard mixture of saline and contrast medium to inflate and cool the balloon to the desired temperature of approximately -10 degrees C. Cryoplasty can be used in combination with other therapies, can be repeated, and offers the advantage of not leaving any foreign objects in the body. In a multicenter registry of claudicants with de novo or restenotic femoropopliteal lesions and in a multicenter trial of CLI patients with infrapopliteal lesions (86.9% mean diameter stenosis, 33.9% occlusions), favorable results with primary cryoplasty included minimal need for bailout stenting, avoidance of repeat revascularization, and high amputation-free survival. We review cases in which cryoplasty was used for diffuse superficial femoral and popliteal artery disease, for infrapopliteal stenosis and occlusion, for in-stent restenosis, and as part of a hybrid strategy for treating multilevel occlusive disease. As these clinical cases demonstrate, cryoplasty therapy can be employed effectively as a primary strategy, or in conjunction with debulking, for the treatment of lesions of varying severity in different segments of the infrainguinal vasculature. Further studies will be required to better define the role of this therapy relative to the other modalities that are currently available for the treatment of femoropopliteal and infrapopliteal disease.

TASC II and the Endovascular Management of Infrainguinal Disease

“…[34][35][36][37][38] Data from several reports featuring these devices do support the TASC II reclassification of femoropopliteal lesions. In a 16-center registry study, Laird et al 39 40 The multicenter Laser Atherectomy for Critical Ischemia (LACI) trial of the CLIRpath Photoablation Atherectomy System involved 423 lesions (41% SFA, 15% popliteal, 41% infrapopliteal; 60% TASC I type D, 28% type C; 11.0-cm median length of treated artery) in 155 limbs (91% with at least 1 occlusion) of 145 CLI patients who were determined to be poor candidates for surgical revascularization.…”

Cryoplasty for Canine Iliac Artery Stenosis and its Impact on Expression of TIMP-2 and MMP-2

“…Banerjee et al 6 treated 27 patients with complex peripheral artery stenosis, with a technical success rate of 100% and a 14-month patency rate of 75%. In a multicenter study of cryotherapy to treat 102 cases with femoral-popliteal artery stenosis, Laird et al 24 reported a technical success rate of 85%, with a 9-month patency rate of 70%.…”

The Polyamine Pathway as a Potential Target for Vascular Diseases: Focus on Restenosis

“…The treatment of atherosclerotic lesions can follow different revascularization strategies, including percutaneous transluminal angioplasty (PTA), stent deployment, cryoplasty [25], rotational or directional atherectomy, and interposition of venous, arterial or synthetic grafts. The interventional approach depends on the localization, number and length of vascular lesions, as well as on patient characteristics and concurrent risk factors.…”