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Comparative Study
. 2014 Sep 22:9:1595-603.
doi: 10.2147/CIA.S66860. eCollection 2014.

Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease

Min Zhou  1 , Dian Huang  1 , Chen Liu  1 , Zhao Liu  1 , Min Zhang  1 , Tong Qiao  1 , Chang-Jian Liu  1
Affiliations
Comparative Study

Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease

Min Zhou et al. Clin Interv Aging. .

Abstract

Objective: To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases.

Design: Case series study with retrospective analysis of prospectively collected nonrandomized data.

Methods: Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan-Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency.

Results: HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P<0.001, respectively), and the presence of diabetes and renal insufficiency were another two independent predictors of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively).

Conclusion: Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency.

Keywords: atherosclerotic occlusive disease; endovascular treatment; hybrid procedure.

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Figures

Figure 1
Figure 1
Primary patency rates of the OPEN and HYBRID groups. Note: There was no statistical difference between the two groups (Kaplan–Meier analysis, log-rank test, P=0.418). Abbreviations: HYBRID, hybrid (combined surgical and endovascular) procedures; OPEN, open surgical reconstructions.
Figure 2
Figure 2
Assisted primary patency rates of the OPEN and HYBRID groups. Note: There was no statistical difference between the two groups (Kaplan–Meier analysis, log-rank test, P=0.517). Abbreviations: HYBRID, hybrid (combined surgical and endovascular) procedures; OPEN, open surgical reconstructions.
Figure 3
Figure 3
Secondary patency rates of OPEN and HYBRID groups. Note: There was no statistical difference between the two groups (Kaplan–Meier analysis, log-rank test, P=0.445). Abbreviations: HYBRID, hybrid (combined surgical and endovascular) procedures; OPEN, open surgical reconstructions.
Figure 4
Figure 4
Limb salvage rates of OPEN and HYBRID groups. Note: There was no statistical difference between the two groups (Kaplan–Meier analysis, log-rank test, P=0.579). Abbreviations: HYBRID, hybrid (combined surgical and endovascular) procedures; OPEN, open surgical reconstructions.
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