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Home > Medical Professionals > Full Index of Images In Vascular Disease > Cryoplasty for superficial femoral artery occlusion

Cryoplasty for Superficial Femoral Artery Occlusion

Scott M Surowiec MD
Mark G. Davies, MD, PhD.
University of Rochester

A 70 yr old female presents with lifestyle limiting claudication in her right leg.  There is a previous history of a fractured femur with placement of an intra-medullary nail for internal fixation.  She has no significant coronary artery disease. She is not a diabetic, did not smoke and has had a serum cholesterol of 250mg/dl, which has been normalized with statin therapy.  She has already undergone an exercise program and seen no benefit from a 3 month course of cilostazol.   Her ABI is 0.8  at rest but drops on standard exercise treadmill testing to 0.4.  Duplex imaging suggested the presence of distal superficial femoral artery occlusion.  The patient underwent an arteriogram, which demonstrated a 3cm occlusion in the distal SFA (TASC B lesion; Figure 1). 

The occlusion was successfully crossed and angioplastied with a 6mm cryoplasty balloon (Polarcath, Boston Scientific) in lieu of primary stent placement (Figure 2).  The technical result was excellent (Figure 3). 

The patient made an uneventful recovery.  At one and six months, the patient was asymptomatic, had an ABI of 1.0, which did not drop on treadmill testing and had a patent superficial femoral artery on duplex imaging.  Cryoplasty offers an attractive alternative endoluminal therapy, which avoids intra-vascular stent placement.

Figure 1 The initial angiogram shows a short segment occlusion of the distal superficial femoral artery.  There is an intra-medullary nail visible in the distal femur.  The remainder of the angiogram showed no inflow disease, a patent popliteal artery and three vessel tibial runoff.

Figure 2 This angiogram shows successful canalization of the occluded segment with a guidewire and the presence of the cryoplasty catheter across the occlusion.  The cryoplasty catheter is inflated.	Figure 3 The completion angiogram shows successful recanalization of the occluded segment with restoration of the lumen and no technical sequalae.  Tibial vessel runoff is preserved. The ankle brachial index was 1.0 after the procedure.