title: Cryoballoon angioplasty broadens the role of primary angioplasty and reduces adjuvant stenting in complex superficial femoral artery lesions.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Bakken
authors.forename: Wael E
authors.initials: WE
authors.lastname: Saad
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D017679:Cryotherapy; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome