Mid-Term Outcomes of Hybrid Revascularisation of Symptomatic Multilevel Peripheral Arterial Disease Across Two Centres

Abstract

Purpose:

This study examined mid-term outcomes in symptomatic patients with peripheral arterial disease (PAD) undergoing hybrid revascularisation (HYR) involving common femoral artery endarterectomy (CFAE) with inflow and/or outflow endovascular procedure in 2 vascular centres.

Results:

A total of 366 consecutive patients (mean age 70.4 years, SD: 9.8 years; 271, 74% males) were identified. Overall, a total of 231 patients (63%) presented with chronic limb-threatening ischaemia. Patients were followed up for a median of 55 months (range 26-84 months). During follow-up, 105 patients (29%) required target lesion revascularisation (TLR). There were 33 patients (9%) who had a major amputation, and 37% (147) patients died resulting in an amputation-free survival (AFS) of 58% (213 patients) over the study period.

Conclusion:

HYR offers reasonable mid-term clinical and technical outcomes for multilevel PAD with diabetes adversely affecting outcomes such as AFS, primary patency (PP), and TLR, while patients on dual antiplatelet therapy post-operatively had favourable PP and TLR.

Clinical Impact

Hybrid lower limb arterial revascularization demonstrates acceptable mid-term outcomes and should be considered in patients with symptomatic multi-level PAD. By integrating open and endovascular techniques, it offers a practical solution for complex disease patterns. Given the paucity of contemporary data, this study provides meaningful evidence that may add to further studies and support the broader use of hybrid approaches in managing advanced PAD.