Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease

Abstract

Objective: To evaluate the feasibility and efficacy of simultaneous combined endovascular and open lower extremity arterial reconstruction.

Design: Case series study with retrospective analysis of prospectively collected non-randomised data.

Methods: Patients were divided into three groups: group 1 and group 2 included patients who underwent endovascular reconstruction proximal and distal to the site of open reconstruction, respectively, whereas group 3 included patients who underwent open surgery with both proximal and distal endoluminal procedures. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency.

Results: Complete data were obtained from 60 patients who underwent 61 single-step hybrid procedures. Technical and haemodynamic success rates were 100% and 95%, respectively. The perioperative mortality rate was 3%. The primary and assisted-primary patency rates at 12 months were 71% and 98%, respectively. Primary patency rates were lower in group 3 when compared with groups 1 and 2 (log-rank test, p=0.006). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency (p=0.003 and p=0.014, respectively).

Conclusions: Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease. The extent of the disease, diabetes and dyslipidaemia are associated with worse outcome.