Hybrid Revascularization Procedures in Acute Limb Ischemia

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

“…Although simple thromboembolectomy or bypass still play a major role in the open treatment of ALI, there is a trend for these patients to have complex, multilevel occlusive disease; they may best be treated by a combination of open and endovascular techniques. 72,94,95 After incomplete thrombo-embolectomy, endovascular techniques such as intra-arterial thrombolysis or thrombus aspiration / mechanical thrombectomy can be used to remove any remaining clot. When completion angiography reveals an underlying chronic stenosis, balloon angioplasty or stenting can be performed to treat the underlying lesion, and prolong patency.…”

Hybrid reconstruction of the upper limb in a patient with chronic limb ischemia

“…7–9 Patients undergoing hybrid revascularization procedures benefit more due to shorter operative duration, shorter hospital stay (including intensive care unit stay), and diminished blood loss, especially those patients with multiple comorbidities. 10 On the other hand, the therapeutic role of hybrid vascular procedures in the emergency setting is not yet established 10 despite the fact that the increase in prevalence of peripheral arterial disease raises the percentage of acute limb ischemia attributed to thrombosis 11 and the risk of limb loss in acute limb ischemia ranges from 5% to 30% with mortality rates approaching 18%. 12–14…”

Treatment of acute lower limb ischaemia

“…Rapid surgical thromboembolectomy combined with transluminal angioplasty and stenting of distal or proximal lesions yields results comparable to traditional bypass surgery with far fewer complications [10,19]. The increasing number of hybrid ORs and growing endovascular experience of vascular surgeons indicate that such procedures will be performed more frequently in ALLI patients, improving the treatment results.…”