Abstract:The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upwar… Show more
“…17,[22][23][24] Some compare hybrid procedures on the basis of indications such as claudication, CLI, and acute limb ischemia or the direction of the endovascular intervention (inflow vs outflow). 13,18,19 Dosluoglu et al 20 compared hybrid revascularization with open and endovascular therapy. Like our findings, hybrid surgery was associated with decreased hospital length of stay and wound infection compared with open surgery.…”
Section: Discussionmentioning
confidence: 99%
“…[10][11][12] Lesions in this anatomic region are usually eccentric, are diffuse, and commonly involve a bifurcation, and because of rigid arterial wall and hip movement, there is an increased risk of stent fracture. [13][14][15] Treatment of disease in the CFA is crucial for FP revascularization. As such, CFA endarterectomy with patch angioplasty remains the standard treatment and is combined with FP bypass when indicated.…”
Objective: Hybrid procedures have gained momentum as less invasive operations that can potentially improve outcomes for patients. However, there is a paucity of data comparing hybrid procedures with traditional bypass. This study compares the perioperative outcomes of hybrid and bypass surgery for femoropopliteal (FP) revascularization. Methods: The American College of Surgeons National Surgical Quality Improvement Program files (2012-2015) were reviewed, and three groups of patients undergoing isolated FP revascularization were identified by Current Procedural Terminology codes. All patients underwent femoral endarterectomy. The hybrid group (HYB) had a concomitant antegrade endovascular FP intervention and was compared with patients with concomitant FP bypass with vein (BPV) and FP bypass with nonvein graft (BPG). The demographics, comorbidities, and outcomes of the three groups were analyzed. The c 2 and analysis of variance tests with post hoc analysis were used. A multivariable logistic regression analysis was performed to identify predictors of readmission, reoperation, and mortality. Results: There were 1480 patients in the analysis. Compared with patients undergoing BPV and BPG, patients in the HYB group tended to be older (P ¼ .016) and were less likely to be smokers (P < .001). They had fewer infected wounds (P ¼ .001) and were more likely to have American Society of Anesthesiologists score #3 (P ¼ .01) and claudication (P < .01). HYB patients had significantly fewer bleeding transfusions (P ¼ .01) and less overall morbidity (P < .001) compared with BPV and BPG patients. The three treatment groups did not differ in frequencies of mortality and major amputation. Among the groups, BPV was associated with the longest operating time (P < .001), whereas HYB had significantly shorter hospital stay (P < .001). HYB was also associated with significantly lower rates of reoperation (P ¼ .017) and readmission (P ¼ .007). On multivariable regression, patients undergoing BPG were at increased risk of readmission (odds ratio [OR], 1.48 [1.00-2.17]) compared with HYB. HYB surgery was associated with less morbidity compared with BPV (OR, 1.38 [1-1.9]) and BPG (OR, 1.77 [1.3-2.38]). Conclusions: Hybrid procedures have favorable perioperative outcomes compared with open bypass for FP revascularization. Additional research on the long-term outcomes of hybrid procedures is needed.
“…17,[22][23][24] Some compare hybrid procedures on the basis of indications such as claudication, CLI, and acute limb ischemia or the direction of the endovascular intervention (inflow vs outflow). 13,18,19 Dosluoglu et al 20 compared hybrid revascularization with open and endovascular therapy. Like our findings, hybrid surgery was associated with decreased hospital length of stay and wound infection compared with open surgery.…”
Section: Discussionmentioning
confidence: 99%
“…[10][11][12] Lesions in this anatomic region are usually eccentric, are diffuse, and commonly involve a bifurcation, and because of rigid arterial wall and hip movement, there is an increased risk of stent fracture. [13][14][15] Treatment of disease in the CFA is crucial for FP revascularization. As such, CFA endarterectomy with patch angioplasty remains the standard treatment and is combined with FP bypass when indicated.…”
Objective: Hybrid procedures have gained momentum as less invasive operations that can potentially improve outcomes for patients. However, there is a paucity of data comparing hybrid procedures with traditional bypass. This study compares the perioperative outcomes of hybrid and bypass surgery for femoropopliteal (FP) revascularization. Methods: The American College of Surgeons National Surgical Quality Improvement Program files (2012-2015) were reviewed, and three groups of patients undergoing isolated FP revascularization were identified by Current Procedural Terminology codes. All patients underwent femoral endarterectomy. The hybrid group (HYB) had a concomitant antegrade endovascular FP intervention and was compared with patients with concomitant FP bypass with vein (BPV) and FP bypass with nonvein graft (BPG). The demographics, comorbidities, and outcomes of the three groups were analyzed. The c 2 and analysis of variance tests with post hoc analysis were used. A multivariable logistic regression analysis was performed to identify predictors of readmission, reoperation, and mortality. Results: There were 1480 patients in the analysis. Compared with patients undergoing BPV and BPG, patients in the HYB group tended to be older (P ¼ .016) and were less likely to be smokers (P < .001). They had fewer infected wounds (P ¼ .001) and were more likely to have American Society of Anesthesiologists score #3 (P ¼ .01) and claudication (P < .01). HYB patients had significantly fewer bleeding transfusions (P ¼ .01) and less overall morbidity (P < .001) compared with BPV and BPG patients. The three treatment groups did not differ in frequencies of mortality and major amputation. Among the groups, BPV was associated with the longest operating time (P < .001), whereas HYB had significantly shorter hospital stay (P < .001). HYB was also associated with significantly lower rates of reoperation (P ¼ .017) and readmission (P ¼ .007). On multivariable regression, patients undergoing BPG were at increased risk of readmission (odds ratio [OR], 1.48 [1.00-2.17]) compared with HYB. HYB surgery was associated with less morbidity compared with BPV (OR, 1.38 [1-1.9]) and BPG (OR, 1.77 [1.3-2.38]). Conclusions: Hybrid procedures have favorable perioperative outcomes compared with open bypass for FP revascularization. Additional research on the long-term outcomes of hybrid procedures is needed.
“…Furthermore, placing a stent across a joint or the inguinal ligament predisposes it to fracture and intimal hyperplasia [13] [14] [18]. The recent evolution of hybrid procedures, utilizing open and endovascular techniques, obviates the risks associated with CFA stenting and has gained increasing popularity in treating multifocal disease [15]- [24]. One advantage of the hybrid procedure is the ability to treat more complex anatomy using less invasive procedures in patients considered high medical risk [16].…”
Section: Discussionmentioning
confidence: 99%
“…Recently, hybrid techniques for multifocal atherosclerotic disease have gained popularity [15]- [24]. These procedures use the proven durability of common femoral endarterectomy with concomitant endovascular management for both inflow and outflow lesions.…”
Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The purpose of this study was to evaluate the effectiveness of the use of a stent graft to stabilize the distal flap and prevent further dissection after extensive endarterectomy. Methods: All patients from Monmouth Medical Center in Long Branch, NJ from September 2008 to March 2013 who underwent an extensive common and superficial femoral (SFA) endarterectomy combined with the use of a Viabahn (Gore Medical) stent graft to stabilize the distal flap were included in the study. These stents were deployed in the proximal SFA after extensive endarterectomy, under direct visualization, without the aid of fluoroscopy. Due to the location in the SFA, these flaps were not amenable to suture tacking. Results: Fifteen patients met these criteria and were included in our study. Twelve patients underwent femoral endarterectomy for severe claudication and three patients for limb salvage. Technical success was achieved in all 15 patients. Five patients also had stents placed proximally to increase inflow and one patient had an additional stent placed distally to improve outflow. There were no intraoperative or postoperative complications. Conclusion: Stent graft placement allows a more extensive endarterectomy to be performed by stabilizing the distal flap allowing a safe transition into the true lumen that is not possible with suture tacking.
“…Сердечно-сосудистые заболевания / Cardiovascular medicine В настоящее время во всем мире для лечения ате-росклеротических поражений подвздошных арте-рий все шире применяются эндоваскулярные вме-шательства, включающие баллонную дилятацию и стентирование [1,2,3,4,5,6,7,8,9,10,11,12]. Однако наряду с ними существует другой малотравматич-ный способ лечения, приобретающий все большую популярность -эндартерэктомия при помощи раз-личных петель и колец (ПЭАЭ).…”
ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ АТЕРОСКЛЕРОТИЧЕСКИХ ПОРАЖЕНИЙ ПОДВЗДОШНЫХ АРТЕРИЙ МЕТОДОМ ПЕТЛЕВОЙ ЭНДАРТЕРЭКТОМИИ РезюмеАктуальность: петлевая эндартерэктомия (ПЭАЭ) является одним из малотравматичных способов современного лечения атеросклероза артерий нижних конечностей.Цель исследования: определение преимуществ и недостатков эндартерэктомии (ПЭАЭ) подвздошных артерий для более успешного внедрения ее как компонента гибридных технологий.Материалы и методы: изучению подверглись результаты лечения 131 пациента, страдающего облитерирующим атеросклерозом артерий нижних конечностей с преимущественным поражением подвздошных артерий. В раннем и позднем (до 5-7 лет) послеоперационных периодах пациентов изучали при помощи анкетного опроса и ультразвукового ангиосканирования, 23 больным выполнена аортоартериография, 68 -СКТ в режиме «ангио».Результаты: в 107 (81,3%) случаях вмешательство удалось осуществить только из бедренного доступа. Дополнительный доступ в забрюшинное пространство потребовался при выполнении 24 (18,3%) операций. Противопоказания для выполнения ПЭАЭ: выраженный кальциноз с поражением всех слоев сосудистой стенки, гипоплазия, извитость или аневризматические расширения подвздошных артерий, высокая окклюзия брюшной аорты. У этих пациентов шунтирование синтетическим протезом является вмешательством выбора. В раннем послеоперационном периоде произошел тромбоз 5 (3,8%) подвергшихся ПЭАЭ подвздошных артерий. Послеоперационный койко-день составил 8+-2 дня. Пятилетняя выживаемость после ПЭАЭ составила 77,1%.Выводы: 1) Проведенное исследование показало, что ПЭАЭ является перспективным, а может быть и приоритетным вмешательством на подвздошных артериях.2) Отдаленные результаты проходимости подвздошных артерий после ПЭАЭ достоверно выше, чем у синтетических шунтов, установленных в аорто-бедренную позицию.3) Отказ от применения синтетических заменителей или сведение их использования до минимума (только в качестве заплаты) значительно уменьшает опасность инфекционных осложнений.Ключевые слова: облитерирующий атеросклероз артерий нижних конечностей, поражение аорто-бедренного сегмента, хирургическое лечение, ранние и отдаленные результаты, полузакрытая петлевая эндартерэктомия.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.