The clinical application of cryoplasty for infrainguinal peripheral arterial disease.

Interventional outcomes for peripheral arterial disease of the lower extremity have long suffered from suboptimal patency rates. Many drugs and devices have been studied in an attempt to alter the aggressive neointimal response witnessed in infra-inguinal vessels with little success. Cryoplasty, a recent entrant into the endovascular arena, combines the time-tested mechanics of percutaneous transluminal angioplasty with the biologically favorable effects of cryotherapy. Cryoplasty specifically targets infra-inguinal lesions and minimizes neointimal proliferation via induction of apoptosis in the cell lines that contribute to restenosis. In addition, the mechanistic effects on the architecture of the vessel wall and the plaque itself have been found to reduce the likelihood of significant dissection following cryoplasty as compared with those expected with percutaneous transluminal angioplasty. Several clinical trials have demonstrated the efficacy of cryoplasty in patients with superficial femoral and popliteal arterial disease, as well as in critical limb ischemia patients with tibioperoneal arterial disease. Current clinical applications in the lower extremity will be reviewed along with technical tips for device use and opportunities for device synergy with other existing technologies.