Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease

Objective Hybrid reconstructions have been increasingly used for multilevel revascularization procedures as surgeons have embraced endovascular interventions. The goal of this study is to define the role of simple and complex hybrid techniques in patients who need multilevel revascularization. Metho...

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Published in:Journal of vascular surgery 2010-06, Vol.51 (6), p.1425-1435.e1
Main Authors: Dosluoglu, Hasan H., MD, Lall, Purandath, MBBS, Cherr, Gregory S., MD, Harris, Linda M., MD, Dryjski, Maciej L., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angioplasty, Balloon - instrumentation
Arterial Occlusive Diseases - diagnostic imaging
Arterial Occlusive Diseases - mortality
Arterial Occlusive Diseases - physiopathology
Arterial Occlusive Diseases - surgery
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Chi-Square Distribution
Comorbidity
Critical Illness
Databases as Topic
Endarterectomy
Female
Femoral Artery - surgery
Humans
Ischemia - diagnostic imaging
Ischemia - mortality
Ischemia - physiopathology
Ischemia - surgery
Kaplan-Meier Estimate
Length of Stay
Limb Salvage
Lower Extremity - blood supply
Male
Medical sciences
Middle Aged
Radiography
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stents
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Outcome
Vascular Patency
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
Vascular Surgical Procedures - adverse effects
Vascular Surgical Procedures - instrumentation
Vascular Surgical Procedures - mortality
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Summary:Objective Hybrid reconstructions have been increasingly used for multilevel revascularization procedures as surgeons have embraced endovascular interventions. The goal of this study is to define the role of simple and complex hybrid techniques in patients who need multilevel revascularization. Methods All patients undergoing arterial revascularization (endovascular [EV], open, hybrid) between June 2001 and May 2008 were included. Hybrid procedures were stratified as simple (sHYBRID group) when the endovascular-treated segment was TransAtlantic Society Consensus II (TASC) A/B, and complex (cHYBRID group), when TASC C/D. Results Of the 654 patients, 770 limbs (67% critical limb ischemia), 226 (29%) had open, 436 (57%) had endovascular, and 108 (14%) had hybrid procedures (56 sHYBRID, 52 cHYBRID). The HYBRID group was more likely to have hypertension, chronic obstructive pulmonary disease, American Society of Anesthesia (ASA) 4, and aortoiliac reconstructions, with more ASA 4 in the cHYBRID than the sHYBRID group. Length of stay in the HYBRID group was significantly longer than the EV group, but less than open-treated groups. Endovascular intervention was performed for inflow in 85%, for runoff in 5%, and for both inflow and runoff in the remaining 10% of hybrid cases. Eleven (20%) sHYBRID cases were staged, while all cHYBRID cases were performed simultaneously. Femoral endarterectomy was more frequent in cHYBRID (75% vs 23% in sHYBRID), infrainguinal bypass (17% vs 55%) was more common in sHYBRID, the remainder being femoro-femoral bypasses (8% vs 21%). Endovascular procedures were primarily iliac interventions (91% in sHYBRID, 88% in cHYBRID). Thirty-day myocardial infarction/death rate was significantly higher in the HYBRID than the EV group, with no difference within the HYBRID group. The patency rates were similar in the sHYBRID and cHYBRID groups, and comparable to the endovascular and open treated patients with similar disease complexity. Limb salvage in patients who presented with critical limb ischemia was better in the cHYBRID group than other groups. Overall survival was similar in all groups. Conclusions Complex and simple hybrid procedures enable multilevel revascularizations in high-risk patients with comparable patency and limb salvage. Femoral endarterectomy plays a central role, especially in complex hybrid repairs. An increase in perioperative morbidity and mortality was observed in the hybrid group, likely due to attempting revascularizatio
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2010.01.092