Simultaneous hybrid revascularization for symptomatic lower extremity arterial occlusive disease

Abstract

Multilevel revascularization, using a combination of endovascular and open (hybrid) surgery, is increasingly being used. Hybrid surgery allows complex anatomy to be treated by minimally invasive procedures in medically high risk patients. The aim of the present study was to report a novel hybrid surgery for lesions in the multilevel lower extremity arteries and to evaluate the clinical outcomes. Consecutive patients who presented at a single institution between March 2009 and Feburary 2012 were selected for inclusion in the study. The patients had disabling claudication or critical limb ischemia and underwent treatment for revascularization by open surgery or by a combination of open surgery and endovascular procedure. Retrospective analysis was conducted from a prospectively collected database. All procedures were performed by a vascular surgeon in an operating room. Postoperative surveillance in outpatient clinics was conducted at 3 and 6 months and every 6 months thereafter. A total of 76 patients were included in the study with a mean age of 67.1±11.3 years (range, 42–94 years) and the male to female ratio was 67:9. The most common indication for revascularization was Rutherford category IV (resting pain). The immediate technical success rate of hybrid surgery was 90.5%, with an overall limb salvage rate of 97.4%. The primary patency rates of the hybrid and open groups were 100 and 90.9%, respectively (P=0.441). Therefore, the results of the present study indicate that hybrid surgery is a feasible option for the treatment of multilevel peripheral arterial occlusive disease, showing favorable patency and limb salvage rates. These observations indicate that femoral endarterectomy plays a vital role in hybrid surgery.

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

“…To our knowledge, this is the fi rst multi-centre study with more than 100 cases performed by the Korean Society for Vascular Surgery. Similar to other recently published series [11,[16][17], femoral endarterectomy (95/134 cases) was a key component of hybrid revascularization in our group series. The early mortality rate was 3.1 %.…”

“…Higher rates of morbidity and mortality were noted in the complex (cHYBRID) group, possibly due to the higher-risk nature of these patients. Some vascular surgeons in our group have reported slight diff erences regarding specifi c surgical techniques in their single-centre HT results [16][17][18]24]. To our knowledge, this is the fi rst multi-centre study with more than 100 cases performed by the Korean Society for Vascular Surgery.…”

“…Several authors [10][11][12][13][14][15][16][17][18] have demonstrated the effi cacy and safety of HT for MR in patients with PAD. However, most studies [10][11][12][13][14][15][16][17][18] have assessed HT safety and effi cacy for MR in patients with PAD using only single-centre studies with few patients.…”

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

“…Particularly for the infrainguinal subset of hybrid procedures, our relatively inferior primary patency rates at one and two years (88% and 76%) compared to parallel 100% (at one year) [25] or 93% (at two years) [26] reported data, probably can be explained by several intrinsic factors of our study group. While the present cohort of patients assembles 83% cumulated TASC II, type C and D severe femoropopliteal disease, other researchers include various similar subsets ranging from 40% [25], to 48% (cHYBRID) [20], exceptionally up to 70% [27] equivalent challenging lesions.…”

“…The technical success, the short-, the long-term patency and appended limb salvage rates of hybrid interventions were documented either in retrospective [20] [26] or prospective studies [26] and seemed to afford at least comparable results to the conventional endovascular and surgical revascularization procedures [19] [24]- [27].…”