Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

Abstract

We treated all of the patients in an operating theatre equipped with a dedicated portable C arm with a specifi c capacity for road mapping and image analysis (BV Pulsera, Philips, DA Best, and the Netherlands) associated with a radiolucent imaging Summary: Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the effi cacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre-and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

Hybrid femoropopliteal procedures are associated with improved perioperative outcomes compared with bypass

“…The outcomes of this large multicenter database analysis are consistent with reported single-center series of morbidity (3%-7%) and mortality (1.1%-6.4%) of hybrid procedures for lower extremity revascularization. 8,[17][18][19][20][21] Most case series are relatively small and just report on periprocedural complications and long-term outcomes regarding patency and limb salvage. 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).…”

“…8,[17][18][19][20][21] Most case series are relatively small and just report on periprocedural complications and long-term outcomes regarding patency and limb salvage. 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.…”

“…Despite the increasing use of hybrid surgery constituting >20% of all open revascularizations, the outcomes are still limited to institutional case series often reporting on a combination of inflow as well as outflow procedures. 17,20,27 Moreover, hybrid surgery is also being frequently used to tackle multiple anatomic levels of arterial occlusive disease in one single operation. In such cases, assessment of outcomes and comparison with standard open bypass become challenging as the hybrid intervention often achieves what has traditionally required two separate bypasses.…”

“…On the other hand, the 1-year limb salvage for treatment of CLI seems to be more consistently achieved at 85% or more. 13,[17][18][19][20][21] There is a paucity of data on reintervention rate after hybrid procedures and the primary modality of failure. Spanos et al 19 reviewed the outcomes of 132 patients undergoing hybrid surgical revascularization.…”

Hybrid treatment of multilevel revascularization in patients with peripheral arterial disease – a multi-centre study in Korea

“…Limb salvage rates at 12 and 36 months in patients with CLI were similar in the endovascular, sHYBRID, and open groups (86 % and 80 %, 94 % and 80 %, and 80 % and 74 %, respectively); however, these rates were improved in the cHYBRID group (100 %; P = 0.014). Granjean et al [25] reported European results with a technical success rate of 100 %. The primary, primary-assisted and secondary patency rates at one year were 39 %, 66 %, and 81 %, respectively.…”