Cryoballoon Angioplasty Broadens the Role of Primary Angioplasty and Reduces Adjuvant Stenting in Complex Superficial Femoral Artery Lesions

Abstract

Cryoballoon angioplasty (CP) for superficial femoral artery (SFA) occlusive disease has attracted attention as an adjunct to primary high-pressure balloon angioplasty (HP) and as an alternative to primary stenting in the SFA. A retrospective review from 1999 to 2005 of patients with chronic critical ischemia because of complex SFA lesions (TransAtlantic Inter-Society Consensus [TASC] C and D) was performed. Those patients treated with either standard HP or CP were examined. Vessels treated by primary stenting or atherectomy were excluded. Eight-five patients with 93 (67%) limbs underwent HP and 39 patients with 45 (33%) limbs underwent CP. Rest pain, tissue loss, or both, were the presenting symptoms in 49% of the HP group and 69% of the CP group. There was no significant difference in the final technical success rate between HP and CP, but significantly more stents were required in HP (75% versus 22%, HP versus CP; p < 0.05). Stenosis rather than occlusion is the more common mode of failure after CP (HP: 68% versus 32%; CP: 38% versus 62%). Despite this, there was no change in 1-year primary (66 +/- 6% versus 69 +/- 9%; HP versus CP; mean +/- SEM), assisted (78 +/- 5% versus 80 +/- 8%), or secondary patencies (78 +/- 5% versus 80 +/- 8%) between the 2 modalities. Freedom from recurrent symptoms and limb salvage for critical ischemia were equivalent. CP substantially increases the number of TASC C and D lesions for which balloon angioplasty alone is effective. Adjuvant stent usage is markedly reduced without a decrease in cumulative patency. Cryoballoon angioplasty should be considered a viable alternative for sole therapy for complex lesions of the SFA.