Cryoplasty Therapy for Limb Salvage in Patients With Critical Limb Ischemia

Abstract

Cryoplasty therapy is a safe and effective method of treating infrapopliteal disease, providing excellent acute outcomes and a high rate of limb salvage in patients with CLI. Study outcomes support the use of cryoplasty therapy as a primary treatment option for patients with CLI secondary to below- knee disease.

Infrapopliteal Percutan Transluminal Angioplasty of Patients with TASC D Group Diabetic Foot Lesions According to the Transatlantic Inter-Society Consensus II

“…Ancak arteriyel yapılarda kronik uzun segment tıkanıklık, yaygın kalsifikasyon, birden çok seviye tutulumu olması perkütan endovasküler işlem başarısını düşürmektedir (24). Son dönemlerde aterektomi, kriyoplasti, kesici balonlar ve lazer anjiyoplastinin diz altı arterlerde güvenle uygulanabileceği gösterilmesine rağmen bu uygulamaların konvansiyonel yöntemlere üstünlüğü olmadığı ve konvansiyonel yöntemlerden daha maliyetli yöntemler olduğu saptanmıştır (25)(26)(27)(28). Yine son yıllarda perkütan işlemlerde ilaç salınımlı balonların etkili olabileceği düşünülmüş ancak bunların konvansiyonel balonlara belirgin üstünlüğü olmadığı çeşitli çalışmalarla gösterilmiştir (29,30).…”

Poor outcomes with cryoplasty for lower extremity arterial occlusive disease

“…Second, we treated very complex lesions in this study compared to most previous studies, which treated mainly Trans Atlantic Inter-Societal Consensus (TASC) A and B lesions. 3,[6][7][8][9] This is emphasized by the mean length of our lesions being 15 cm. Bakken et al 10 also have shown poor initial technical success of 78% with cryoplasty in more challenging lesions.…”

“…Third, the majority of lesions treated with cryoplasty in our study were reinterventions compared to previous studies in which all were de novo lesions. [3][4][5][6][7] Interestingly, some of our initial cryoplasty failures responded to balloon angioplasty. This may indicate that some lesions require a higher inflation pressure, which cannot be delivered via cryoplasty.…”

“…5 A large, multicenter study by Laird et al 6 shows clinical patency rates for cryoplasty to be 82.3% after 300 days and maintained at 75% after 3 years. Furthermore, Das et al 7 have shown cryoplasty to be "a safe and effective method of treating infrapopliteal disease, providing excellent acute outcomes and a high rate of limb salvage in patients with critical limb ischemia" with an amputation-survival rate of 89.3% at 180 days. While cryoplasty has been shown to decrease the rate of restenosis and increase vessel patency in these studies, the researchers did not differentiate between patients with in-stent restenosis and those with native lesions.…”

An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries: A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)

“…In addition, several adjunctive endovascular devices, including atherectomy, cryoplasty, cutting balloons, and laser, have been shown to be feasible and safe in the infrapopliteal vessels but have failed to show superior efficacy when compared to conventional, less expensive therapies. 45,[63][64][65] These devices add cost to the basic endovascular procedure, and therefore their added expense needs to be justified. 66) The data suffer from many of the limitations of the observational surgical series in that they largely represent the retrospective reports or uncontrolled registries, subject to selection bias, at individual centers.…”