Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period  Institutional Experience

Alexandrescu, Vlad; Jacquemin, Jean-Luc; Wuidar, Pierre-Arnaud; Azdad, Khalid; Triffaux, François

doi:10.4236/wjcd.2016.62005

Cited by 7 publications

(19 citation statements)

References 28 publications

(100 reference statements)

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“…This appears particularly important in treating high-risk ASA "3-4" surgical patients. (19,20) The present chapter completes previous published research of our vascular interventional team focusing on the same topic, (22,23) and adds extended clinical experience, study cohort, and statistical analysis, with updated consultation on this subject.…”

Section: Introductionmentioning

confidence: 83%

The Role of Hybrid Femoropopliteal Revascularization in High-risk (ASA 3-4) Patients: A Decade of Dual Center Clinical Experience

Alexandrescu¹,

Barriat²,

Schoenen³

et al. 2021

Research Trends and Challenges in Medical Science Vol. 8

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BACKGROUND:The present chapter focus on eventual clinical benefit of hybrid revascularizations gathering common femoral artery (CFA) endarterectomy coupled to femoropopliteal endovascular recanalization in high-risk ASA Class 3-4 patients having severe infrainguinal multilevel occlusive disease. MATERIAL AND METHODS:From January 2009 until November 2019, a series of 205 hybrid infrainguinal interventions performed in 178 ASA Class 3-4 patients (Rutherford category 2-6 ischemic presentations) were retrospectively analyzed. Patient demographics, specific risk factors, technical characteristics, parallel to patency, limb salvage and survival results were examined during a mean 44.9 months of follow-up. In the whole, long (>15 cm) and intermediate (5-15 cm) CTO were present in 198 (96%) of all ischemic limbs, in parallel to severe CFA atherosclerotic disease. Two or three runoff tibial trunks were evinced in 172 (84%) cases, while moderate-to-severe arterial calcifications were present in 78 (38%) cases. RESULTS:Inasmuch the surgical approach was successful in all cases, the endovascular step of all hybrid interventions was technically rewarding in 190 (93%) cases. The postoperative ABI improved (> 1.5) in 75% of cases, while clinical presentations gained at least one Rutherford category in 182 (89%) limbs. The postoperative 30-day mortality rate noted in this specific "high-risk" group of patients was 3.3% The mean hospital stay was 6.2 days (3-14 days) Primary patency estimates revealed 88% (95% CI 84% to 91%) and 66% (95% CI 56% to 75%) at 12 and 60 months, while limb salvage was 93% (95% CI 88% to 95%) and 80% (95% CI 72% to 86%) at the same time intervals, respectively. Global risk factors alike smoking (p=0.003) and female gender (p=0.001), together with CTOs length (>15 cm / p=0.016), severe calcifications (p=0.049), poor tibial runoff (p=0.018, and p=0.001 for 1, and 0 permeable trunks), the GLASS/FP grade "4" lesions (p=0.039), and the stent length (>6 cm / p=0.001), showed parallel negative influence on primary patency. CONCLUSION:Hybrid infrainguinal revascularization may offer beneficial option for treatment options in high-risk ASA 3-4 patients. Careful patient selection and technique planning appear essential for achieving appropriate arterial reconstruction and limb salvage outcome.

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Section: Introductionmentioning

confidence: 83%

The Role of Hybrid Femoropopliteal Revascularization in High-risk (ASA 3-4) Patients: A Decade of Dual Center Clinical Experience

Alexandrescu¹,

Barriat²,

Schoenen³

et al. 2021

Research Trends and Challenges in Medical Science Vol. 8

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“…Over the past decades, a shift from surgical to endovascular revascularization approaches has been well recognized and is associated with lower individual procedural costs and lower procedural risk but comparable to improved outcomes [4,9,[23][24][25]. Apart from sole endovascular or surgical revascularization approaches, joint hybrid interventions are increasingly performed showing less complications, lower mortality and shorter hospitalization compared to open surgical revascularizations [16,17,26,27].…”

Section: Discussionmentioning

confidence: 99%

Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

Decker

Helmer

Bette

et al. 2022

Cardiovasc Intervent Radiol

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Objective To analyze trends and differences of endovascular, surgical and hybrid revascularization approaches and the impact of comorbidity on characteristics, costs, and outcome of in-patients with peripheral artery disease (PAD) of the lower extremity. Methods Analyzing data provided by the Research Data Center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine IIb (Rutherford 2–3) or higher in Germany between 2009–2011 and 2016–2018. According to the individually performed procedures encoded by the Operation and Procedure Classification System, we divided hospitalizations by revascularization procedures into sole endovascular, sole surgical, hybrid, two-step and no revascularization. Patient’s comorbidity was assessed using the linear van Walraven comorbidity score (vWs). Results 1,067,671 hospitalizations (mean age 71.3 ± 11.1 years; 60.1% male) were analyzed. Between 2009–2011 and 2016–2018, reimbursement costs rose by 28.0% from €2.72 billion (€5,350/case) to €3.49 billion (€6,238/case). The share of hospitalizations with any revascularization increased by 8.9% (67.7–73.7%) driven by an increase in two-step (+ 63.3%), hybrid (+ 58.2%) and sole endovascular revascularizations (+ 32.6%), while sole surgical approaches declined (− 18.2%). Hospitalizations of more comorbid patients (vWs ≥ 20) rose by 46.8% (21,444–31,478 cases), showed an overproportionate increase in costs of 124.6% (+ €1,750/case) and were associated with more individual procedures (+ 90.6%). Conclusions In-patient treatment of PAD patients shows increasing numbers of hybrid and sole endovascular revascularizations and more patients with higher comorbidity, while sole surgical interventions and in-hospital mortality decrease. Consequently, associated costs are surging especially in more comorbid patients due to an increasing number of performed procedures and escalation of therapy.

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“…15,20 Advancements in devices, embracement of interventional skills by surgeons, and development of hybrid operating rooms have made hybrid procedures an integral part of LER strategy 21,22 and improved limb salvage particularly in high-risk patients. [23][24][25] Hybrid procedures are thought to be cost-effective and shorten the lengths of stay in the hospital. 14,16,24,26 The rise in the performance of hybrid procedures in the United States is indeed in line with international trends.…”

Section: Discussionmentioning

confidence: 99%

National trends of hybrid lower extremity revascularization in the ACS-NSQIP database

Fereydooni

Zhou²,

Jorshery

et al. 2019

Vascular

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Objectives Despite reports of increasing use of hybrid surgery for lower extremity revascularization in Europe, little is known about the performance of hybrid procedures in the U.S. This study aims to investigate contemporary national trends in frequency and operator distribution of hybrid lower extremity revascularization and compare the perioperative outcomes of independent vascular surgeons and other surgical specialists. We hypothesized that hybrid procedures are increasingly performed, and independent vascular surgeons have superior outcomes compared to other surgical specialists. Methods The 2005–2015 American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was used to identify patients undergoing open or hybrid lower extremity revascularization based on Current Procedural Terminology codes. Only patients treated for peripheral artery disease, based on International Classification of Diseases codes-9, were included. A trend of yearly hybrid lower extremity revascularization compared to open lower extremity revascularization was obtained. The most commonly performed hybrid procedure was identified as well as the specialties of the primary operators. Operators were categorized as “independent vascular surgeons” and “other surgeons” if the primary operator was a non-vascular surgeon or a vascular surgeon assisted by a second specialist as part of a team. Patients undergoing this hybrid lower extremity revascularization by independent vascular surgeons were selected and matched (2:1) to the patients who underwent the same procedure by other surgical specialists. Matching was based on age, gender, functional status, American Society of Anesthesiologists classification, transfer status, emergent surgery, and indication. The characteristics and perioperative outcomes of those two groups were compared. Results The overall rate of hybrid procedures increased from 4% in 2005 to 14% in 2015 ( p < 0.0001). During this period, vascular surgeons independently performed 92.9% of all hybrid surgeries, with no significant change in the yearly trend ( p = 0.15). Femoral endarterectomy with retrograde aortoiliac intervention was identified as the most common procedure, accounting for 35.7% and 33.3% of hybrid lower extremity revascularization performed by independent vascular surgeons and other surgeons, respectively. After propensity matching, there were 212 patients treated by independent vascular surgeons and 106 patients treated by other surgeons, with no significant difference in demographics or comorbidities. There was no difference between independent vascular surgeons and other surgeons in mortality (1.4% and 2.8%, respectively, p = 0.30), overall morbidity (19.3% and 18.9% respectively, p = 0.91), and other complications. Conclusion Hybrid lower extremity revascularization for peripheral artery disease has been increasingly used and is performed primarily by independent vascular surgeons. Simple hybrid procedures may be performed safely by vascular surgeons as well as other trained surgical specialists.

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Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period Institutional Experience

Cited by 7 publications

References 28 publications

The Role of Hybrid Femoropopliteal Revascularization in High-risk (ASA 3-4) Patients: A Decade of Dual Center Clinical Experience

The Role of Hybrid Femoropopliteal Revascularization in High-risk (ASA 3-4) Patients: A Decade of Dual Center Clinical Experience

Comparison and Trends of Endovascular, Surgical and Hybrid Revascularizations and the Influence of Comorbidity in 1 Million Hospitalizations Due to Peripheral Artery Disease in Germany Between 2009 and 2018

National trends of hybrid lower extremity revascularization in the ACS-NSQIP database

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