Cryoplasty Versus Conventional Balloon Angioplasty of the Femoropopliteal Artery in Diabetic Patients: Long-Term Results from a Prospective Randomized Single-Center Controlled Trial

Spiliοpoulos, Stavros; Κατσάνος, Κωνσταντίνος; Karnabatidis, Dimitris; Diamantopoulos, Athanasios; Kagadis, George C.; Christeas, Nikolaos; Siablis, Dimitris

doi:10.1007/s00270-010-9915-x

Cited by 53 publications

(31 citation statements)

References 46 publications

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“…A meta-analysis of head-to-head RCTs of paclitaxel-coated balloons (THUNDER, FEMPAC, LEVANT I & PACIFIER) with standard uncoated balloon angioplasty have shown a significant reduction of angiographic binary restenosis (OR = 0.26) and target lesion revascularization (OR = 0.22) at 6 months [7]. Balloon cryoplasty seems to have limited effectiveness [74,75]. Of note, there is limited cost-utility or cost-effectiveness data about any of the previously mentioned techniques in the femoropopliteal artery.…”

Section: Postprocedural Follow-up Carementioning

confidence: 99%

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

Κατσάνος

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Tsetis

et al. 2014

Cardiovasc Intervent Radiol

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This is a Standards of Practice document endorsed by CIRSE. The authors performed a literature review and provide recommendations and quality improvement guidelines based on the most recent and highest level of evidence available to date on the field of Superficial Femoral and Popliteal Artery Angioplasty and Stenting. Standards for the use of basic and more advanced endovascular techniques in the femoropopliteal arteries are reported and relevant aspects of case selection, imaging, follow-up, and overall patient management are presented to guide endovascular practice in Europe.

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Section: Postprocedural Follow-up Carementioning

confidence: 99%

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

Κατσάνος

Tepe

Tsetis

et al. 2014

Cardiovasc Intervent Radiol

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“…Despite observational data showing lower rate of stenting after cryoplasty, this could not be validated in two small randomized trials, where the rate of stenting after cryoplasty remained comparable to PTA. 16,17 The main benefit of altering compliance appears to be in less dissection and bailout stenting. In the Calcium 360 trial 7 and the PTA versus atherectomy plus adjunctive PTA study, 6 TLR was not statistically reduced despite less dissection and stenting although TLR rate trended less in the debulking arm.…”

mentioning

confidence: 99%

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Shammas¹

2013

Int J Angiol

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ReviewPeripheral arterial disease is highly prevalent in the general population affecting 12 to 14% of people and leading to claudication or threatened limb ischemia. 1 Endovascular lower extremity arterial interventions have increased exponentially over the past decade. 2 The femoropopliteal (FP) segment represents 40% of vessels treated and its treatment continues to be a challenge to the endovascular specialist. Despite a high rate of acute procedural success, target lesion revascularization (TLR) and target vessel revascularization remain elevated. 3,4 We have previously proposed a triad of optimal peripheral vascular revascularization strategy (►Fig. 1) 5 with an emphasis on three key principles: (1) Mechanical, improve vessel compliance to allow dilatation of a stenotic segment at low balloon inflation pressure and reduce dissection and recoil. Low balloon inflation pressure would theoretically preserve vessel integrity by minimizing barotrauma and bailout stenting. (2) Biological, inhibit smooth muscle cell (SMC) proliferation to improve patency rates and reduce repeat revascularization. (3) Procedural, preserve the outflow vessels by minimizing distal embolization (DE) and reduce procedural time and radiation exposure to both operator and patient.In this overview, we examine these principles to determine whether current data support their validity. We recognize the lack of uniform performance criteria and reporting standards in clinical trials in peripheral arterial disease. This unfortunately makes comparisons across studies difficult. Mechanical FactorsThe concept of improving vessel compliance as a prerequisite to a more definitive treatment of the FP artery has gained more attention over the past few years. Measurement of vessel compliance in vivo is difficult to obtain. One surrogate endpoint is the minimum balloon pressure (MBP) needed to fully stretch the artery to a lumen diameter equal to a normal reference segment with the use of a noncompliant balloon sized 1:1 to the reference vessel. The balloon is typically inflated to two atmospheres then the inflation pressure is increased by increment of one atmosphere at a time until full balloon expansion is achieved. 6,7 According to Laplace's law, tension (T) in the vessel wall is equal to (pressure (P) gradient across the arterial wall * radius (R) of artery)/wall thickening (M), or (T¼ [P * R]/M). In order for MBP change to reflect on compliance, the segments under comparison need to have similar radius and lesion Keywords AbstractTreatment of the femoropopliteal (FP) artery remains a challenge to the endovascular specialist. Long-term patency is low with a high rate of target lesion revascularization. The true patency rate varies considerably between studies partly because there is a lack of uniform performance criteria and reporting standards in peripheral arterial interventions. Literature review supports three principles that emerge as important components of an optimal strategy in treating the FP artery: (1) improving vessel compliance and sub...

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“…Another randomised study reported similar conclusions from a cohort of diabetic patients who underwent a single cryoplasty treatment, showing better results than PTA in the immediate, short and long-term in the femoropopliteal arteries [8]. However, in other randomised studies of femoropopliteal lesions, cryoplasty and PTA had the same TLR at mid-term [9][10][11], failing to demonstrate an overwhelming benefit of cryoplasty over PTA. A recent retrospective record review of reinterventions for in-stent restenosis in the femoropopliteal segment showed that recurrent stenosis-free survival was significantly lower in the cryoplasty cohort at short-term and mid-term postdilation [12].…”

Section: Introductionmentioning

confidence: 74%

Cryoplasty versus angioplasty in the treatment of arterial restenosis in an experimental model of atherosclerosis in rabbits

et al. 2015

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Cryoplasty Versus Conventional Balloon Angioplasty of the Femoropopliteal Artery in Diabetic Patients: Long-Term Results from a Prospective Randomized Single-Center Controlled Trial

Cited by 53 publications

References 46 publications

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

An Overview of Optimal Endovascular Strategy in Treating the Femoropopliteal Artery: Mechanical, Biological, and Procedural Factors

Cryoplasty versus angioplasty in the treatment of arterial restenosis in an experimental model of atherosclerosis in rabbits

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