Hybrid Vascular Approach Reduces the Intensive Care Unit Stay in Patients With Chronically Threatening Limb Ischemia and Multilevel Atherosclerotic Lesions

Abstract

Chronic limb-threatening ischemia represents the fi nal stage of atherosclerosis and is often associated with signifi cantcardiovascular morbidity leading to high mortality. The hybrid approach combines surgical and endovascular techniques toachieve maximal revascularization of multilevel atherosclerotic lesions in the lower limb, with a shorter procedure time and less trauma compared to the classical method. It is also expected to reduce the length of hospital stay.The aim of the study is to analyze the relationship between the hybrid approach and the length of stay in the intensive careunit (ICU) compared to the classical vascular surgical approach in patients with chronic limb-threatening ischemia, multilevel atherosclerosis and high anesthesiological risk. Another endpoint is to compare the total ventilation time in the two groups.Material and methods. The study compares ICU length of stay and total mechanical ventilation time between two groups –a prospective group (n=48) of patients treated with hybrid revascularization and a control group (n=50) treated with classicalvascular revascularization. Patients included had multi- level atherosclerotic lesions (aorta- iliac, femur- popliteal and outfl ow) and chronic limb-threatening ischemia (Fontaine Grade III and IV). A database was created with subsequent statistical analysis using «SPSS» software. Tests used: Chi-square, p-value, frequencies. The chi-squared test was considered valid if the test statistic is chi-squared distributed under the null hypothesis, specifi cally Pearson’s chi-squared test. If the null hypothesis that there are no diff erences between classes in the population is true, the test statistic calculated from the observations follows a χ2 frequency distribution. If the p-value is greater than alpha, then we have not rejectedthe null hypothesis and assume that there is no signifi cant diff erence between the two samples. We set the signifi cance level at 0.05. The study protocol was approved by the Commission on Biomedical Ethics of the Bukovinian State Medical University (minutes of the Commission meeting No 4 from the 19.12.2023 year). The theme of the complex research work «Development, justifi cation and implementation of new approaches to the diagnosis and treatment of some acute surgical diseases, prediction of their course and prevention of complications (state registration number: 0121U110501, terms of execution: 01.2021-12.0225).Results. ICU length of stay and total ventilation time were analyzed in the two groups. Both ICU and total ventilation timeswere shorter with statistical signifi cance in the hybrid approach group. Therefore, the use of hybrid revascularization contributes to an accelerated stabilization of the patient’s condition. Therefore, the use of the hybrid vascular approach contributes to an accelerated stabilization of the patient’s condition. This reduces the duration of treatment, the cost of treatment. So, hybrid vascular approach is a promising way to treat limb ischemia. This approach needs further implementation in practice. The novelty added by the manuscript to the already published scientifi c literature: Hybrid revascularization itself represents a relatively new type of treatment for patients with multilevel atherosclerotic lesions. The analysis of the length of stay in the intensive care unit of patients undergoing hybrid revascularization compared to classic surgical revascularization adds to the current literature.Conclusions. ICU length of stay for patients with chronic limb-threatening ischemia and multilevel atherosclerosis, as wellas total mechanical ventilation time, is shorter with statistical signifi cance when hybrid revascularization is used compared with traditional vascular surgery.