Featured Case: CryoPlasty Case Study

A 78-year-old man presented with a nonhealing ulcer on the medial aspect of the fifth toe of his left foot. His medical history was significant for hypertension, diabetes mellitus, carotid artery disease and hyperlipidemia.

The patient was taking Altace (King Pharmaceuticals, Inc., Bristol, Tennessee), Lipitor (Pfizer, New York, New York), Toprol XL (AstraZeneca, Wilmington, Delaware) and Plavix ASA (Sanofi Aventis, Bridgewater, New Jersey). He had had a prior coronary artery bypass graft (CABG) surgery.

His right leg ankle brachial index (ABI) was 0.8 and his left leg ABI was 0.4, resting. The angiogram of the distal popliteal artery revealed an occluded anterior tibial artery and diffuse vascular involvement of the posterior tibial artery. A more distal lower-extremity angiogram showed diffuse vascular involvement of the peroneal artery and occluded posterior and anterior tibial arteries. Distal angiogram of the left foot showed reconstitution of the posterior tibial artery by collaterals of the foot, filling the pedal arch.

The posterior tibial artery was crossed with a hydrophilic 0.014" Glidewire (Terumo, Tokyo, Japan). No balloon catheters would cross the heavily calcified, diffusely diseased occlusion, which required a 0.9-mm excimer laser catheter (Spectranetics, Colorado Springs, Colorado) to create a channel. The patient then underwent cryoplasty of his posterior tibial artery with overlapping 3 mm x 6 cm PolarCath Peripheral Dilatation System (Boston Scientific, Natick, Massachusetts) inflations.

The patient went on to heal the ulcer in 30 days and remained symptom free at the 6-month follow-up visit.