HYBRID INTERVENTIONS IN EMERGENCY ANGIOSURGERY

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection. Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine-Pokrovsky classification: 4 patients (25%) - IIb, 8 (25%) - III, 4 (25%) - IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2). Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation - 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml. Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

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One-stop hybrid surgery for treatment of complex Stanford type B aortic dissection

Journal of International Medical Research ◽

10.1177/0300060520957933 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052095793

Author(s):

Yongzhong Guo ◽

Jinjie Shao ◽

Wenjian Shi ◽

Mei Tian ◽

Ling Li ◽

...

Keyword(s):

Aortic Dissection ◽

Length Of Hospital Stay ◽

Type B ◽

Type B Aortic Dissection ◽

Elephant Trunk ◽

Hybrid Surgery ◽

One Stop ◽

Elephant Trunk Procedure ◽

Mechanical Ventilation Time ◽

Stanford Type B

Objectives To compare the efficacy and prognosis of one-stop hybrid surgery using the elephant trunk procedure for treatment of complex Stanford type B aortic dissection. Methods We retrospectively analyzed patients who underwent surgical treatment from January 2014 to July 2019. The patients were divided into those who underwent the elephant trunk procedure (n = 10) and those who underwent one-stop hybrid surgery (n = 10). The cardiopulmonary bypass time, mechanical ventilation time, length of hospital stay, and red blood cell usage were compared between the two groups. All patients’ 3-month postoperative aortic computed tomography angiography (CTA) findings were also reviewed. Results The cardiopulmonary bypass time, mechanical ventilation time, and length of hospital stay were significantly shorter and red blood cell usage was significantly lower in the one-stop hybridization group. The aortic cross-clamp time was not significantly different between the two groups. Aortic CTA review after hybrid surgery showed that the true lumen of the descending aorta was almost completely restored at 3 months. Conclusion One-stop hybrid surgery effectively alleviated the occlusion of the aortic dissection, prevented the need for additional surgery, and expanded the indications for covered-stent endovascular repair.

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Endograft infection after hybrid surgery for chronic Stanford type B aortic dissection: endograft infection and treatment

Surgery Today ◽

10.1007/s00595-015-1148-9 ◽

2015 ◽

Vol 45 (12) ◽

pp. 1575-1578 ◽

Cited By ~ 1

Author(s):

Manabu Yamasaki ◽

Kohei Abe ◽

Hiroyasu Misumi ◽

Joji Ito ◽

Yusuke Nakanishi ◽

...

Keyword(s):

Aortic Dissection ◽

Type B ◽

Type B Aortic Dissection ◽

Hybrid Surgery ◽

Endograft Infection ◽

Stanford Type B

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Hybrid surgery in patients with chronic ischemia of lower extremities

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2012-1-43-46 ◽

2018 ◽

Vol 16 (1) ◽

pp. 43 ◽

Cited By ~ 1

Author(s):

A. A. Karpenko ◽

V. B. Starodubtsev ◽

M. A. Chernyavskiy ◽

P. V. Ignatenko

Keyword(s):

Lower Extremities ◽

Surgical Trauma ◽

Open Heart ◽

Chronic Ischemia ◽

Hybrid Surgery ◽

Surgical Interventions ◽

Hybrid Technologies

54 patients who underwent hybrid surgical interventions (stenting and open-heart operations) because of occlusive/stenotic damages of the arteries of the lower extremities were enrolled in our study. In all cases positive angiographic results were obtained. During follow-up 5 patients (9.3%) had hematoma and lymphorrhea was observed in 3 patients (5.6%), both complications occurring in the surgical zone. The usage of hybrid technologies enables us to effectively treat patients with multilevel damages of the arteries of the lower extremities, to reduce morbidity and surgical trauma.

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THE HYBRID SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF LOWER EXTREMITIES

Medical Journal of the Russian Federation ◽

10.18821/0869-2106-2017-23-5-233-236 ◽

2017 ◽

Vol 23 (5) ◽

pp. 233-236 ◽

Cited By ~ 1

Author(s):

M. B Temrezov ◽

Vladimir I. Kovalenko ◽

R. S Bulgarov ◽

A. S Bakhmetev ◽

T. Kh Temrezov ◽

...

Keyword(s):

Clinical Success ◽

Lower Extremities ◽

Primary Patency ◽

Direct Access ◽

Secondary Patency ◽

Critical Ischemia ◽

Severe Condition ◽

Iliac Arteries ◽

Surgical Interventions ◽

Multi Level

The purpose of study is to evaluate efficiency of hybrid surgical interventions under critical anemia of lower extremities in patients with multi-level atherosclerosis affection of arterial bed.The material and methods. The results of surgical treatment using hybrid technology are analyzed. The sampling consisted of 38 patients (33 males and 5 females) suffering from critical anemia of lower extremities because of multi-level atherosclerosis affection of main arteries. The average age was 69,6±2,5 years. The 21 patients (group 1) underwent balloon angioplasty with stenting of iliac arteries through direct access in femoral artery using balloon enlarging stents Asssurant and at the same time instant femoral popliteal stenting. The 17 patients (group 2) underwent stenting of iliac arteries combined with endarterectomy from common and deep arteries of thigh with profundoplastics.The results. The immediate and distant results of treatment in both groups had no differences. After endovascular interventions at iliac segment a primary technical success was achieved in 92.1% of cases and a clinical success - at 81.1% of cases. In the zone of open vascular interventions in femoral popliteal segment primary and secondary patency made up to 89.5% and 97.4% correspondingly. The rate of keeping of extremity in general made up to 92.1% and lethality - 7.9%. The distant results up to three years were monitored in 35 patients. The primary patency in the zone of endovascular intervention after 1, 2 and 3 years made up to 89,8, 76,2 and 68,5% correspondingly. In 5 patients (13.2%) repeated operations were implemented. The level of keeping of extremity after 1,2 and 3 years made up to 77.4%, 74.1% и 72.5%. The survival after 1,2 and 3 years made up to 94,3%, 88,6% and 85,7% correspondingly.The conclusion. The hybrid interventions (stenting of iliac arteries combined with surgical adjustment of femoral popliteal segment) under critical ischemia of lower extremities in the first place are effective and expedient for patients in severe condition and high surgical risk.

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HYBRID SURGERY IN MULTI-FLOOR ATHEROSCLEROTIC INFLAMMATION OF THE MAIN ARTERIES OF THE LOWER LIMBS

Клінічна та профілактична медицина ◽

10.31612/2616-4868.4(18).2021.04 ◽

2021 ◽

Vol 4 (18) ◽

pp. 27-31

Author(s):

V.Y. Smorzhevsky ◽

I.S. Pizhovskyi ◽

P.A. Gindich

Keyword(s):

Lower Extremities ◽

Early Postoperative Period ◽

Lower Limbs ◽

Hybrid Surgery ◽

Medical Problems ◽

Optimal Method ◽

Surgical Interventions ◽

Limited Mobility ◽

Choice Of Treatment ◽

New Research

Cardiovascular diseases occupy one of the main groups in the structure of morbidity in most countries. A significant part of this group is affected by the main arteries of the lower extremities. Atherosclerotic diseases of the terminal aorta are combined with stenotic-occlusive lesions of the iliac-femoral, femoral-popliteal and popliteal-tibial arterial segments. Timely diagnosis and choice of treatment to maintain a full life remains one of the most pressing medical problems today. Comprehensive drug therapy used in the treatment of this pathology is ineffective and leads to limb loss, which leads to limited mobility, ability to self-care, contributes to social maladaptation and requires the involvement of the working population to care for the patient. All of the above has led to an expansion of readings to restorative operations aimed at preserving the limbs. However, reconstructive surgery of stenotic-occlusive diseases of the arteries of the lower extremities today is a complex and far from unresolved problem, which contributes to the development of new research to select the optimal method of surgical treatment. The article presents data on hybrid surgical interventions (open surgery and stenting) in 59 patients with chronic ischemia of the lower extremities. The early postoperative period in 4 (6.8%) patients was complicated by hematoma and in 5 patients (8.5%) by postoperative wound lymphorrhea. Hybrid surgeries, in chronic lower extremity ischemia in patients with multilevel lesions of the main arteries, are effective and minimally invasive, especially in patients at high risk of complications. Such technologies allow to save the limb and life of the patient with the minimum trauma, to reduce duration of stay in a hospital.

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Anatomic-hemodynamical types of recurrence of the lower extremities varicose disease

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2021.5-6.23 ◽

2021 ◽

Vol 88 (5-6) ◽

pp. 23-27

Author(s):

A. O. Guch ◽

A. O. Bobrova

Keyword(s):

Surgical Intervention ◽

Lower Extremities ◽

Disease Recurrence ◽

Postoperative Recurrence ◽

Duplex Scanning ◽

Surgical Interventions ◽

Results Of Treatment ◽

Varicose Disease

Objective. To improve the results of treatment in patients with postoperative recurrence of varicose disease of the lower extremities with the help of studying of peculiarities of disorders in regional venous hemodynamics and determination of anatomic-hemodynamic types of the disease. Materials and methods. There were examined 85 patients with postoperative recurrence of varicose disease of the lower extremities. Ultrasonic duplex scanning of veins was performed on apparatus «EnVisor», manufactured by «Philips» (Holland) using a multifrequency linear sensor with the 12 - 5 MHz frequency for subcutaneous veins and a convex sensor with the 5 - 2 MHz frequency - for deep veins. Results. There were delineated 8 anatomic-hemodynamical types of recurrences of varicose disease of the lower extremities. The investigation conducted have permitted to systematize the causes and signs of the disease. Objective criteria for prognostication of the varicose disease of the lower extremities recurrence may be applied for optimization of volume of primary surgical intervention and prophylaxis of its complications. Conclusion. The main causes of the recurrence development in varicose disease of the lower extremities are tactical and technical mistakes of surgeons during performance of primary surgical interventions in patients, suffering varicose disease of the lower extremities. Studying of peculiarities in development of recurrence of varicose disease of the lower extremities permits to elaborate the practical anatomic-hemodynamical classification, which systematizes the main causes of the varicose disease recurrence and constitutes the base for the reoperations tactics elaboration.

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Hybrid surgical interventions in treatment of cholangitis and biliary sepsis on the background of cholecystocholedocholithiasis

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2019-178-3-34-38 ◽

2019 ◽

Vol 178 (3) ◽

pp. 34-38

Author(s):

D. N. Popov ◽

A. O. Tantsev ◽

T. O. Nikitina ◽

A. U. Korolkov

Keyword(s):

Comparative Analysis ◽

Acute Cholecystitis ◽

Biliary Tract ◽

Acute Cholangitis ◽

Single Stage ◽

Treatment Results ◽

Hybrid Surgery ◽

Surgical Interventions ◽

Results Of Treatment ◽

Biliary Sepsis

The OBJECTIVE of the study was to improve the results of treatment in patients with cholecystocholedocholithiasis complicated with acute cholangitis and biliary sepsis by analyzing the possibilities of hybrid surgery.MATERIAL AND METHODS. 126 patients with acute cholecystitis, cholangitis and biliary sepsis on the background of the cholecystocholedocholithiasis were treated during the period 2015–2018. We performed the comparative analysis of treatment results in different groups for evaluating the effectiveness of various hybrid operations.RESULTS. When analyzing the comparison of treatment results we determined that single-stage laparoscopic biliary tract lavage was more effective in the case of large or multiple bile ductus stones. Endoscopic transpapillary management performed by «Rendezvous» method was more effective than endoscopic papillosphincterotomy.CONCLUSION. With the development of acute cholecystitis, cholangitis and biliary sepsis on the background of cholecystocholedocholithiasis, the implementation of single-stage hybrid surgical interventions taking into a specificity for each of the methods was indicated.

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Hybrid treatment of multilevel revascularization in patients with peripheral arterial disease – a multi-centre study in Korea

VASA ◽

10.1024/0301-1526/a000694 ◽

2018 ◽

Vol 47 (3) ◽

pp. 235-241 ◽

Cited By ~ 2

Author(s):

Soon Cheon Lee ◽

Jin Hyun Joh ◽

Jeong-Hwan Chang ◽

Hyung-Kee Kim ◽

Jang Yong Kim ◽

...

Keyword(s):

Endovascular Treatment ◽

Combined Treatment ◽

Ankle Brachial Index ◽

Primary Patency ◽

Limb Ischaemia ◽

University Hospitals ◽

Multi Centre Study ◽

Free Survival ◽

Technical Success Rate ◽

Hybrid Treatment

Abstract. Background: Endovascular treatment is an alternative first-line management for peripheral artery disease (PAD). Hybrid treatment (HT) is defined as a combined treatment for patients with PAD using endovascular and open surgery, simultaneously performed in an operating room. The results of HT are reportedly good for multilevel revascularization (MR) in patients with chronic limb ischaemia, and even in older high-risk patients. The goal of this study was to examine the clinical and haemodynamic outcomes of HT in patients who need MR. Patients and methods: Nine university hospitals in Korea participated in this multicentre study. A total of 134 patients with multilevel PAD underwent HT and MR. Patients were enrolled from July 2014 to June 2015 and were followed for 18 months. Results: The mean age of the patients was 68.8 ± 9.93 years and 88.1 % were men. Patients with Rutherford category 2 to 3 and 4 to 6 comprised 59.0 % and 42.0 % of the group, respectively. The technical success rate was 100 %. The primary patency rates at 12 and 18 months were 77.6 % and 63.9 %, respectively. The primary-assisted patency rates at 12 and 18 months were both 90.0 %. The pre-operative mean ankle brachial index (0.43 ± 0.23) increased to 0.87 ± 0.23 at six months post-operatively (t-test, p < 0.05). The amputation free survival rate was 97.1 %. Conclusions: Although outcomes of multilevel PAD are reportedly poor when endovascular treatment alone is used, we have shown that HT is a feasible alternative modality for patients with multilevel PAD, with satisfactory amputation-free survival and freedom from re-intervention rates.

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