Hybrid procedures and femoral endarterectomy in diabetic patients

Abstract

Objective: The aim of the study is to evaluate the safety and effectiveness of common femoral endarterectomy (CFE) in critical limb ischemia (CLI) associated with proximal and distal endovascular (EV) revascularization in diabetic (type 1 and type 2) and non-diabetic patients.

Patients and methods: We analyzed patients from January 2008 to December 2011 who underwent one-staged hybrid procedures. Patients were divided into three groups: group 1 = EV reconstruction proximal to the CFE, group 2 = EV procedures distal to the CFE, group 3 = both proximal and distal EV procedures. Patients were evaluated at 6 and 36 months after the procedures, and the mean follow-up was 42 ± 20.3 months.

Results: A total of 43 (79% men; aged 74.4 ± 8.6 years) out of 635 (5.5%) patients operated for CLI fulfilled the inclusion criteria; 23 (53.5%) had type 1 or type 2 diabetes mellitus (DM). DM patients were younger than controls (p = 0.048). The patient distribution was 14 in Group 1 (32.5%), 24 in Group 2 (55.8%) and 5 in Group 3 (11.7%). CFE was successful in all cases, while associated EV procedures were successful in 90.7% of patients. Peri-operative morbidity and mortality were 11.6% and 2.3%, respectively. Survival rates at 6 and 36 months were 93% and 71.9%, respectively. Three patients (6.98%) underwent a major amputation. The cumulative limb salvage was 95.2% at 6 months and 92.1% at 36 months. No recurrent CFE stenosis was observed. No differences in survival, amputation or patency rates emerged between DM and non-DM patients or among the three EV revascularization groups.

Conclusions: Hybrid procedures are safe and effective both in CLI patients with or without DM, and they should be taken into consideration whenever indications are present.