RESUMEN
Endovascular techniques have been playing an increasing role in managing lower extremity chronic critical limb ischemia (CLI) in patients considered poor or non-candidates for surgical revascularization secondary to co-morbidities such as coronary artery disease, uncontrolled hypertension, diabetes mellitus or inadequate conduit. This study reviews our recent clinical experience in the treatment of peripheral artery disease solely using cryoplasty. A retrospective cohort study was performed. The cohort consisted of 88 patients who underwent lower extremity revascularization utilizing cryoplasty between December 2003 and August 2007. Indications for intervention included poor wound healing after forefoot amputation or persistent ulceration of the foot, disabling claudication and rest pain. Kaplan-Meier analysis was performed to assess salvage rates. One hundred twenty-six lesions were treated in 88 patients. Technical success rate was 97%. Limb salvage rates were 75 and 63% for patients with critical limbs ischemia after one and three years, respectively. A history of smoking was associated with a threefold increased risk of limb loss. In conclusion, endovascular management of lower extremity lesions with cryoplasty is an emerging and viable paradigm in the treatment of CLI in an attempt to preserve limbs and avoid major amputations.
Asunto(s)
Criocirugía , Isquemia/cirugía , Recuperación del Miembro , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Distribución de Chi-Cuadrado , Connecticut , Criocirugía/efectos adversos , Femenino , Humanos , Isquemia/etiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Selección de Paciente , Enfermedad Arterial Periférica/complicaciones , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Cryosurgery dates back to the 19th century, with the description of the benefits of local application of cooling for conditions such as pain control. Once commercial liquefied gases became available, more progress was made in the use of cryotherapy for localized lesions. As understanding of disease response to freezing increased, safer techniques for performing freezing procedures helped prepare its clinical application in different clinical situations, such as prostate disease and bronchial cancers. Cryosurgical techniques are less invasive and have lower morbidity compared with surgical resection. However, the use of cryosurgery has been limited by a lack of good understanding of the underlying mechanisms of tissue destruction. To apply cryosurgery clinically, and to extend its use, it is important to understand the mechanisms of freeze injury on cells, and to control the thermal parameters.