Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Anouk Grandjean ◽  
Katia Iglesias ◽  
Céline Dubuis ◽  
Sébastien Déglise ◽  
Jean-Marc Corpataux ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Early Mortality ◽  
Secondary Patency ◽  
Limb Salvage Rate ◽  
Peripheral Arterial ◽  
Salvage Rate

Abstract. Background: Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease. Patients and methods: A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments. Results: 64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 − 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %. Conclusions: The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.

scholarly journals Intercondylar Route of Prosthetic Infragenicular Femoropopliteal Bypass Has Better Primary, Assisted, and Secondary Patency but Not Limb Salvage Rate Compared to the Medial Route

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Tomas Grus ◽  
Lukas Lambert ◽  
Rohan Banerjee ◽  
Gabriela Grusova ◽  
Vilem Rohn ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Arterial Disease ◽  
Observation Time ◽  
Secondary Patency ◽  
Femoropopliteal Bypass ◽  
Limb Salvage Rate ◽  
Group A ◽  
Group B ◽  
Peripheral Arterial ◽  
Salvage Rate

Aim. To compare the differences between medial and intercondylar infragenicular femoropopliteal prosthetic bypasses in terms of their midterm patency and limb salvage rates.Methods. Ninety-three consecutive patients with peripheral arterial disease who underwent a simple distal femoropopliteal bypass using a reinforced polytetrafluorethylene graft were included in this retrospective study. The bypass was constructed in the intercondylar route in 52 of the patients (group A) and in 41 in the medial route (group B).Results. Median observation time of the patients was 12.7 (IQR 4.6–18.5) months. There were 22 and 24 interventional or surgical procedures (angioplasty, stenting, thrombolysis, thrombectomy, or correction of the anastomosis) performed to restore patency of the reconstruction in groups A and B, respectively (p=0.14). The 20-month primary, assisted, and secondary patency rates and limb salvage rates were 57%, 57%, 81%, and 80% in group A compared to 21%, 23%, 55%, and 82% in group B (p=0.0012, 0.0052, 0.022, and 0.44, resp.).Conclusion. Despite better primary, assisted, and secondary patency rates in patients with a prosthetic infragenicular femoropopliteal bypass embedded in the intercondylar fossa compared to patients with the medial approach, there is no benefit in terms of the limb salvage rate and the number of interventions required to maintain patency of the reconstruction.

scholarly journals Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia

2021 ◽  
Vol 10 (13) ◽  
pp. 2865
Author(s):  
Felice Pecoraro ◽  
David Pakeliani ◽  
Salvatore Bruno ◽  
Ettore Dinoto ◽  
Francesca Ferlito ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Hybrid Approach ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Major Amputation ◽  
Primary Patency ◽  
Secondary Patency ◽  
Peripheral Arterial

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported. Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months. Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively. Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.

scholarly journals TO BALLOON OR TO BYPASS? HYBRID APPROACH FOR COMPLEX PERIPHERAL ARTERIAL DISEASE

2020 ◽  
Vol 75 (11) ◽  
pp. 3195
Author(s):  
Tasleem Katchi ◽  
Linda Ferrer ◽  
Nader Lamaa ◽  
Joseph Reimon ◽  
Bryan Curry ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Hybrid Approach ◽  
Arterial Disease ◽  
Peripheral Arterial

Limb Salvage in Patients With Peripheral Arterial Disease Managed by Endovascular First Approach

2013 ◽  
Vol 48 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Kyin Kyin May ◽  
Peter Ashley Robless ◽  
Harvinder Raj Singh Sidhu ◽  
Ben Soo Yeng Chua ◽  
Pei Ho
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Arterial Disease ◽  
Peripheral Arterial

scholarly journals Predictors of post-operative outcomes in patients with peripheral arterial disease and critical limb ischaemia: a systematic review and meta-analysis

2021 ◽  
Vol 55 (1) ◽  
pp. 69-76
Author(s):  
Lily P. Wu ◽  
Nadraj G. Naidoo ◽  
Olatunji O. Adetokunboh
Keyword(s):  
Peripheral Arterial Disease ◽  
Limb Salvage ◽  
Graft Patency ◽  
Arterial Disease ◽  
Critical Limb Ischaemia ◽  
Wound Complications ◽  
Limb Ischaemia ◽  
Operative Outcomes ◽  
One Year ◽  
Peripheral Arterial

Background: A very small proportion (1%) of patients with peripheral artery disease (PAD) present with critical limb threatening ischaemia (CLTI) with poor prognosis. The present review showcased several pre-operative predictors and key post-operative outcomes. Identification of any modifiable predictors may impact positively on surgical outcomes.Design: PubMed/Medline, Google scholar and Cochrane databases were searched using terms such as “peripheral arterial disease” AND “critical limb ischemia,” “post-operative outcome,” AND “predictors of post-operative outcomes”. Search was for relevant English-language articles published between January 1997 and December 2007 Selected articles were screened first by title and abstract, and selection of full articles was based on relevance using our inclusion and exclusion criteria and quality ratings performed with the MINORS score.Results: The included studies were published between 1997 and 2007. Only six (6) articles out of a total of 2,114 were deemed suitable for analysis. Ambulatory recovery was >70% at six months, 86.7% and 70.0% at one year and five years respectively. Rate of local wound complications was between 12% and 24%. Reported limb salvage rates were >90% at six months, >70% at one year and 70.0-90.0% at five years. Primary graft patency rate at one year ranged from 63% and 76.6%. Gangrene, diabetes and impaired pre-operative ambulatory function are associated with more wound complications, low limb salvage, reduced graft patency and poor functional outcome.Conclusion: Pre-operative ambulatory status was the most important predictor of post-operative ambulatory recovery. Diabetes mellitus was an important risk factor for prolonged wound healing, local wound complications and major amputation.

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