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Case Reports
. 2020;77S(Suppl):S166-S169.
doi: 10.1016/j.ijscr.2020.09.018. Epub 2020 Sep 22.

Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease

Ettore Dinoto  1 , Felice Pecoraro  2 , Andrea Cutrupi  3 , Umberto M Bracale  4 , Marco Panagrosso  4 , Guido Bajardi  2
Affiliations
Case Reports

Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease

Ettore Dinoto et al. Int J Surg Case Rep. 2020.

Abstract

Introduction: Multilevel peripheral arterial disease (MPAD) is the main cause of critic limb ischemia (CLI). Vascular interventions are required to increase distal blood flow and reduce the risk of lower limb amputation.

Presentation of case: We report a case of complex hybrid revascularization in a patient presenting a Rutherford V MPAD involving the infrarenal aorta, iliac, femoral and popliteal segments. The simultaneous hybrid intervention consisted of an endovascular aortic stent-graft placement and a surgical above-the-knee prosthetic femoro-popliteal bypass. In the same operation a renal stenting was performed due to a significant renal artery stenosis associated to a systemic hypertension non-responder to medical management.

Discussion: Hybrid interventions can be performed simultaneously or staged with benefit given by the complementary role of endovascular and surgical treatments allowing the correction of eventually inadequate results of both approaches. Reports of simultaneous hybrid treatments are limited but, despite the complexity of such procedures, primary success rate is reported high. Also in the reported case, a complex simultaneous treatment in a patient presenting MPAD in association to a significant and symptomatic renal artery disease was feasible in the same operation.

Conclusion: Hybrid procedure are safe with high degree of efficacy in terms of revascularization procedure, reduced morbidity and shorter intensive care and hospital stay. In our experience, the use of hybrid procedure is technically feasible and allowed the treatment of MPAD with a good outcomes.

Keywords: Case report; Endovascular; Hybrid procedure; Peripheral arterial disease; Revascularization.

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Figures

Fig. 1
Fig. 1
Preoperative CT-angiography showing significant atherosclerotic aortic disease in correspondence of the infrarenal aortic segment and right renal artery.
Fig. 2
Fig. 2
Preoperative CT maximum intensity projection showing atherosclerotic occlusion of the bilateral femoro-popliteal segments.
Fig. 3
Fig. 3
Completion intraoperative angiography showing the correct positioning and patency of the aortic stent-graft.
Fig. 4
Fig. 4
Postoperative CT maximum intensity projection showing maintained patency of the femoro-popliteal bypass.
See this image and copyright information in PMC

References

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