Hybrid-Based External Iliac Endarterectomy With Stenting Provides Superior Primary Patency Compared With External Iliac Artery Stenting Alone

Abstract

Objectives: Nearly 25% of vascular surgery patients operated on for peripheral vascular disease are readmitted within 30 days. While most readmissions follow revascularization procedures, postoperative complications following lower extremity amputations (LEA) contribute significantly. Great interest exists in reducing readmissions given associated morbidity, mortality, and cost. Intraoperative fluorescent angiography (IFA) is evaluated for ability to predict skin-flap viability following LEA.Methods: IFA using indocyanine green dye (ICG) was studied retrospectively at a single institution. Absolute and relative tissue perfusion values were evaluated for sensitivity and specificity in regard to skin-flap viability. Records of patients undergoing LEA with use of IFA by two vascular surgeons from 2013 to 2014 were reviewed.Results: Thirteen patients, mean age 70.5 years (standard deviation [SD], 12.0 years; range, 49-93 years), underwent 17 amputations. Indications included rest pain and tissue gangrene. Amputation levels included toe (23%), transmetatarsal (18%), below-knee (41%), and above-knee (18%). Six (35%) LEA required revision with a mean time-to-revision of 26.1 days (SD, 19.9 days; range, 9-61 days). Of these revisions, 83% proceeded to a proximal level amputation. Mean follow-up was 235 days (SD, 148 days; range, 5-448 days), and IFA was used in all cases. Absolute perfusion scores between 5 and 9 displayed sensitivity and specificity of 50% and 64%, respectively (Fig 1). Additionally, a relative perfusion value of #31% displayed 100% sensitivity and specificity. Sensitivity and specificity fell to 83% at a relative perfusion of #27% and #35%, respectively (Fig 2).Conclusions: IFA during LEA is safe and easily performed by the vascular surgeon. Relative perfusion values as a predictor of skin-flap viability