Objective
Extensive multilevel atherosclerotic disease is common in patients with ischemia of the lower extremities. It is frequently associated with multiple medical comorbidities, resulting from disease in distant vascular territories and making these patients the high-risk group for extensive open surgical procedures. The purpose of this study is to evaluate the feasibility and efficacy of simultaneous, combined endovascular, and open lower extremity arterial reconstruction.
Patients and methods
A case series study with retrospective analysis of prospectively collected nonrandomized data.
Results
Thirty-five patients with multilevel ischemic peripheral vascular disease underwent hybrid procedures during the period from September 2014 to September 2016 with 100% technical success rate. Inflow endovascular procedure was performed in 48.57% and outflow in 37.14% of the cases. For five (14.28%) patients, both inflow and outflow percutaneous transluminal angioplasty were performed together with an open surgical revascularization. The open surgical procedures were a femoral procedure in the groin (34.3%) or with a bypass (65.7%). Patients are maintained on clopidogrel 75 mg daily for at least 6 weeks after hybrid interventions. Thereafter, lifelong aspirin therapy can be substituted for clopidogrel. The mean duration of the operation for all hybrid procedures was 290±110 min (range: 60–580 min). It was longest in procedures where an inflow percutaneous transluminal angioplasty (±stenting) and distal bypass were combined (279 min).
Conclusion
Hybrid revascularization procedures for the treatment of multilevel vascular disease in the fragile vascular patient population seem to be as good as with open revascularization, but with less morbidity and shorter intensive care and hospital stay.