Hybrid Revascularization Combining Iliofemoral Endarterectomy and Iliac Stent Grafting for TransAtlantic Inter-Society Consensus C and D Aortoiliac Occlusive Disease

Ray, Juliet J.; Eidelson, Sarah A.; Karcutskie, Charles A.; Meizoso, Jonathan P.; DeAmorim, Hilene; Goldstein, Lee J.; Karwowski, John K.; Bornak, Arash

doi:10.1016/j.avsg.2017.11.061

Cited by 14 publications

(6 citation statements)

References 23 publications

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“…10 In comparison, in another study with a mean follow-up duration of 23 months, the primary patency rate was 85.4% for the hybrid approach of femoral endarterectomy and stenting in patients with C-and D-type lesions. 11 Previous studies have reported that the 1-and 3-year primary patency rates of endovascular treatment ranged from 70% to 97% and 66% to 91%, respectively, in patients with C-and D-type lesions. 9,10,[12][13][14][15][16][17] Several studies reported that the patency rates of endovascular treatment in patients with D-type lesions ranged from 85% to 93% at 1 year and 80% to 93.75% at 2 years.…”

Section: Discussionmentioning

confidence: 97%

Comparison of Clinical Outcomes of Endovascular Therapy and Hybrid Surgery in the Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Occlusive Disease

Guo¹,

Yanyu²,

Zhang³

et al. 2023

IJGM

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Purpose To study and compare the clinical outcomes of endovascular therapy with those of hybrid surgery in the treatment of Trans-Atlantic Inter-Society Consensus II (TASC II) D aortoiliac occlusive disease (AIOD). Patients and Methods Patients with TASC II D-type AIOD who underwent their first surgical treatment at our hospital between March 2018 and March 2021 were enrolled and followed up to evaluate the improvement in symptoms, complications, and primary patency. The Kaplan–Meier method was used to compare the differences in primary patency between the treatment groups. Results In total, 132 of 139 enrolled patients (94.96%) achieved technical success following treatment. The perioperative mortality rate was 1.44% (2/139), and postoperative complications occurred in two patients. Among the patients who successfully underwent surgery, 120 underwent endovascular treatment (110 patients with stenting and 10 patients with thrombolysis before stenting), 10 underwent hybrid surgery, and 2 underwent open surgery. The follow-up data were compared between the endovascular and hybrid groups. At the end of the follow-up period, the patency rates in the hybrid and endovascular groups were 100% and 89.17% (107/120), respectively. The endovascular group achieved primary patency rates of 94.12%, 92.44%, and 89.08% at 6, 12, and 24 months postoperatively, respectively, whereas the primary patency rate remained at 100% in the hybrid group, with no significant variation between the endovascular and hybrid groups ( P = 0.289). The endovascular group was further divided into a stent subgroup (110 patients) and a thrombolysis/stent subgroup (10 patients), and no prominent variation was noted in the primary patency between the two subgroups ( P = 0.276). Conclusion Although open surgery is the gold standard treatment for TASC II D-type AIOD, endovascular and hybrid treatments are feasible and effective. Both methods showed good technical success and early to midterm primary patency rates.

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Section: Discussionmentioning

confidence: 97%

Comparison of Clinical Outcomes of Endovascular Therapy and Hybrid Surgery in the Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Occlusive Disease

Guo¹,

Yanyu²,

Zhang³

et al. 2023

IJGM

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“…This is a challenging issue especially for extensive iliofemoral occlusive disease. While endovascular interventions have a large share among conventional open surgical methods for treating iliofemoral occlusive disease, as it became preferred by cardiovascular surgeons [6], a new paradigm shift has emerged and paved the way for hybrid-based approach as open surgical femoral endarterectomy with endovascular in-flow recanalization [7]. The aim of this study was to further explain a less invasive procedure that has been approved safe in treating severe occlusions in iliac artery [4].…”

Section: Discussionmentioning

confidence: 99%

Hybrid-based approach for pervasive occlusive disease of iliofemoral arteries

Saricaoglu,

Ozcinar

2023

Turk J Vasc Surg

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Aim: Simultaneous multilevel hybrid-based reconstructions using both endovascular and open femoral endartectomy merit the interest with the widespread adoption of these techniques by vascular surgeons. Here we presented our experience on hybrid-based approach to treat total occlusive iliofemoral lesions and study the technical success and mid-term results of combined femoral endarterectomy and endovascular treatment of iliac occlusion. Material and Methods: This retrospective single center study included patients with only total occlusion in the unilateral iliac artery. The patients underwent hybrid procedure–open femoral endarterectomy and endovascular revascularization of the external or common iliac artery- between 2016 and 2022. Statistical analysis was performed by using SPSS software version 25. Results: Totally 103 patients who underwent hybrid procedures for pervasive unilateral iliac artery occlusions were included in this study. Of the study cohort, 76% were male patients with a mean age of 74±8.7 years. Technical success rate was 89.3%. Acute myocardial infarction was the most common complication. The 30-day mortality was 7.8% (n=8) and all of them were in-hospital deaths. The survival rates of this cohort at 30 days, 6 months and 12 months were 92.2%, 88.1% and 83.7%, respectively. The primary patency at 30 days, 6 months, and 12 months were 98.1%, 96.6%, and 93.7%, respectively. Conclusion: The clinical and technical outcomes in this study suggest that the hybrid approach to pervasive iliofemoral occlusions, combining femoral endarterectomy and endovascular iliac revascularization, is an effective and applicable treatment in terms of patency rates and perioperative complications.

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“…[1][2][3][4] The combined, hybrid iliofemoral endarterectomy with iliac stenting has been reported in the past as an effective treatment mode. [2][3][4][5][6][7][8] Several practices have been suggested accordingly, combining a eversion femoral endarterectomy extending to the level past the inferior epigastric artery and inguinal ligament with an iliac angioplasty performed over a guidewire crossing the iliac lesion either retrogradely or in a cross-over manner and retrieved through a femoral sheath or an open femoral arteriotomy. 3,7,8 Additionally, a remote balloon-assisted mollring iliac endarterectomy followed by femoral endarterectomy and iliac stenting has been also described.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Several practices have been suggested accordingly, combining a eversion femoral endarterectomy extending to the level past the inferior epigastric artery and inguinal ligament with an iliac angioplasty performed over a guidewire crossing the iliac lesion either retrogradely or in a cross-over manner and retrieved through a femoral sheath or an open femoral arteriotomy. 3,7,8 Additionally, a remote balloon-assisted mollring iliac endarterectomy followed by femoral endarterectomy and iliac stenting has been also described. 5,6 Our experience with the abovementioned therapeutic approach led us to adopt and standardize certain maneuvers to the anatomic limitations in order to avoid technical failure and ensure successful and efficient restoration of iliofemoral patency.…”

Section: Introductionmentioning

confidence: 99%

Tips and Tricks to Facilitate the Combined Iliofemoral Endarterectomy With Stenting for Heavily Calcified Common Femoral Artery Atherosclerosis With Involvement of the External Iliac Artery

Georgakarakos,

Dimitriadis,

Parisidis

et al. 2023

Vasc Endovascular Surg

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Background Management of a heavily calcified atherosclerotic occlusive disease involving the common femoral artery (CFA) and external iliac artery (EIA), poses a surgical challenge. Though the current guidelines recommend open surgical therapy for such lesions, this approach is neither easy nor represents the current real-life practice. Purpose To describe tips and tricks facilitating the hybrid technique for the management of distal iliofemoral atherosclerotic disease, where classic endarterectomy is inadequate or ill-performed. Technique A contralateraly inserted guidewire reaches the distal iliac artery via the crossover technique and is directly retrieved from the femoral arteriotomy immediately after removal of the anterior plaque segment. The retrieved and secured guidewire enables extensive retrograde CFA endarterectomy over the wire with avusion proximally to the inguinal ligement, followed by patch arterioplasty. Externalizing the guidewire from the patch enables traction on it and facilitates advancement of the stent through tortuous or stenosed iliac vessels as well as accurate stent deployment to cover the margin of the EIA residual plaque. Moreover, this manipulation enables ipsilateral placement of a sheath and passage of a second, retrograde guidewire to perform kissing stenting in the common iliac vessels. Chronic thrombotic lesions require covered stents to avoid thrombus propagation and meticulous flushing before completion of the femoral patching. Conclusions The combined iliofemoral endarterectomy with stenting does not require advanced endovascular skills and prevents complications associated with incomplete femoral endarterectomy. Extensive avulsion endarterectomy proximal to the inguinal ligament is efficiently and safely performed over a retrieved crossover guidewire, enabling precise residual stenting above the flexion site.

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Hybrid Revascularization Combining Iliofemoral Endarterectomy and Iliac Stent Grafting for TransAtlantic Inter-Society Consensus C and D Aortoiliac Occlusive Disease

Cited by 14 publications

References 23 publications

Comparison of Clinical Outcomes of Endovascular Therapy and Hybrid Surgery in the Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Occlusive Disease

Comparison of Clinical Outcomes of Endovascular Therapy and Hybrid Surgery in the Treatment of Trans-Atlantic Inter-Society Consensus II D Aortoiliac Occlusive Disease

Hybrid-based approach for pervasive occlusive disease of iliofemoral arteries

Tips and Tricks to Facilitate the Combined Iliofemoral Endarterectomy With Stenting for Heavily Calcified Common Femoral Artery Atherosclerosis With Involvement of the External Iliac Artery

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