Silva Guilherme V, Fernandes Marlos R, Cardoso Cristiano O, Miranda William R, Strickman Neil, Mortazavi Ali, Hernandez-Vila Eduardo A, Achari Arup, Krajcer Zvonimir
Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Tex Heart Inst J. 2011;38(2):122-6.
Endovascular treatment of peripheral artery occlusive disease has suboptimal long-term patency rates. The addition of cryoplasty to balloon angioplasty, which involves the application of cold thermal energy to atherosclerotic plaque, might improve outcomes and decrease the need for reintervention. At a single tertiary center, we retrospectively analyzed data from the angiograms and medical records of unselected patients who underwent cryoplasty for peripheral artery disease from January 2004 through November 2006. We calculated rates of freedom from amputation, freedom from intervention, and freedom from death and examined the data using the Kaplan-Meier method. Paired t tests were used to compare the ankle-brachial indices before and after cryoplasty. The study population comprised 99 patients who received treatment for 132 atherosclerotic lesions, including 62 lesions in the superficial femoral artery, 28 in the popliteal artery, and 25 in arteries below the knee; 71 patients completed follow-up (64 ± 57 wk). Short-term periprocedural success was achieved in 98.5% of the interventions. Dissections occurred in 12.2% of patients treated successfully without bail-out stenting or additional balloon inflations. At 6 months, more than 88% of the patients were alive and had not had an amputation. However, reintervention was required for 42% of patients. Mean ankle-brachial indices improved significantly after treatment (P < 0.0001). Our results show that cryoplasty for treatment of peripheral artery disease is safe and has a high rate of periprocedural success. However, long-term efficacy is compromised because of the frequent need for reintervention.
外周动脉闭塞性疾病的血管内治疗长期通畅率欠佳。在球囊血管成形术基础上加用冷冻球囊血管成形术（即将冷热能作用于动脉粥样硬化斑块）可能改善治疗效果并减少再次干预的需求。在一家三级医疗中心，我们回顾性分析了2004年1月至2006年11月期间因外周动脉疾病接受冷冻球囊血管成形术的未经挑选患者的血管造影和病历数据。我们计算了无截肢生存率、无干预生存率和无死亡生存率，并采用Kaplan-Meier方法分析数据。采用配对t检验比较冷冻球囊血管成形术前、后的踝肱指数。研究人群包括99例患者，共治疗132处动脉粥样硬化病变，其中股浅动脉病变62处，腘动脉病变28处，膝下动脉病变25处；71例患者完成随访（64±57周）。98.5%的干预获得了短期围手术期成功。在未使用补救支架或额外球囊扩张的成功治疗患者中，12.2%发生了夹层。6个月时，超过88%的患者存活且未行截肢术。然而，42%的患者需要再次干预。治疗后平均踝肱指数显著改善（P<0.0001）。我们的结果表明，冷冻球囊血管成形术治疗外周动脉疾病是安全的，围手术期成功率高。然而，由于频繁需要再次干预，其长期疗效受到影响。
