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Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2008 Settembre;15(3):207-11
Is cryoplasty the best treatment for peripheral arterial disease?
Shafique S., Murphy M. P., Dalsing M. C.
Department of Vascular Surgery Indiana University School of Medicine, Indianapolis, IN, USA
Endoluminal therapy has become the first line of treatment for superficial femoral artery disease. Despite high initial technical success by angiographic evaluation, a number of problems continue to adversely affect long term patency of conventional balloon angioplasty. Significant problems that often necessitate stent placement following peripheral arterial disease (PTA) include residual plaque burden, dissection, and elastic recoil. Long term success rates are further troubled by recurrent stenosis due to neointimal hyperplasia, with balloon angioplasty or stent placement. Cryoplasty is a unique innovation in that it combines the mechanical vessel dilatation with delivery of cold thermal energy. Combining the two modes of treating the atherosclerotic plaque may theoretically prevent many of the aforementioned problems in the immediate and long term. Cryotherapy has other applications such as ablation of cutaneous lesions, obliteration of tumors, and treatment of other biologic tissues such as cervical dysplasia and hemorrhoids. Cryotherapy has applications in endovascular treatment of superficial femoral disease, popliteal and tibial vessel disease. It offers theoretical advantage over balloon angioplasty due to combination of mechanical dilatation of stenotic lesion and cold thermal stimulus to the intima which has the potential to decrease intimal hyperplasia by causing apoptosis of cells. Technical success and short term patency rates are promising but long term durability has not been demonstrated. There is no prospective randomized data to suggest that cryoplasty is superior to conventional balloon angioplasty.