Laird John R, Dawson David L
Department of Medicine, Division of Cardiovascular Medicine, UC Davis Vascular Center, Sacramento, California 95817, USA.
J Endovasc Ther. 2009 Apr;16(2 Suppl 2):II116-28. doi: 10.1583/08-2653.1.
Cryoplasty has been shown to be safe and effective for the treatment of atherosclerotic lesions in the peripheral vasculature and offers the promise of improving on the results of percutaneous transluminal angioplasty (PTA) by limiting dissection, vessel recoil, and restenosis. The PolarCath Peripheral Dilatation System utilizes nitrous oxide rather than the standard mixture of saline and contrast medium to inflate and cool the balloon to the desired temperature of approximately -10 degrees C. Cryoplasty can be used in combination with other therapies, can be repeated, and offers the advantage of not leaving any foreign objects in the body. In a multicenter registry of claudicants with de novo or restenotic femoropopliteal lesions and in a multicenter trial of CLI patients with infrapopliteal lesions (86.9% mean diameter stenosis, 33.9% occlusions), favorable results with primary cryoplasty included minimal need for bailout stenting, avoidance of repeat revascularization, and high amputation-free survival. We review cases in which cryoplasty was used for diffuse superficial femoral and popliteal artery disease, for infrapopliteal stenosis and occlusion, for in-stent restenosis, and as part of a hybrid strategy for treating multilevel occlusive disease. As these clinical cases demonstrate, cryoplasty therapy can be employed effectively as a primary strategy, or in conjunction with debulking, for the treatment of lesions of varying severity in different segments of the infrainguinal vasculature. Further studies will be required to better define the role of this therapy relative to the other modalities that are currently available for the treatment of femoropopliteal and infrapopliteal disease.
冷冻球囊血管成形术已被证明在治疗外周血管系统的动脉粥样硬化病变方面是安全有效的，并且有望通过限制夹层形成、血管回缩和再狭窄来改善经皮腔内血管成形术（PTA）的效果。PolarCath外周扩张系统利用一氧化二氮而非标准的盐水和造影剂混合物来充盈球囊并将其冷却至约-10摄氏度的所需温度。冷冻球囊血管成形术可与其他疗法联合使用，可重复进行，且具有不会在体内留下任何异物的优点。在一项针对初发或再狭窄股腘病变跛行患者的多中心登记研究以及一项针对腘下病变慢性肢体缺血（CLI）患者的多中心试验（平均直径狭窄86.9%，闭塞33.9%）中，初次冷冻球囊血管成形术的良好结果包括对补救性支架置入的需求最小、避免再次血管重建以及高保肢生存率。我们回顾了冷冻球囊血管成形术用于弥漫性股浅动脉和腘动脉疾病、腘下狭窄和闭塞、支架内再狭窄以及作为治疗多节段闭塞性疾病混合策略一部分的病例。正如这些临床病例所示，冷冻球囊血管成形术可有效地作为主要策略，或与减容术联合使用，用于治疗腹股沟下血管系统不同节段不同严重程度的病变。需要进一步的研究来更好地确定这种疗法相对于目前可用于治疗股腘和腘下疾病的其他方式的作用。
