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Abstract

Objective

The aim of the study was to evaluate the outcome of first line hybrid treatment in patients with chronic limb threatening ischemia (CLTI) and to evaluate possible predictors of primary patency (PP) loss and limb clinical improvement (LCI).

Methods

This was a retrospective non-randomized study. All patients underwent one-stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularization procedure. Demographic, clinical, and lesion characteristics for each patient were reported. Primary patency analysis was performed using Kaplan–Meier life tables, and univariate and multivariate analysis was used to assess possible predictors of PP loss and clinical improvement.

Results

Complete data were obtained from 132 patients. Patients were divided into two groups according to their Rutherford’s category (RC), group 1 (Rutherford 4) and group 2 (Rutherford 5 and 6). Technical success was 98%. The overall surgical peri-operative complication rate was 8%. At a mean follow-up of 32 ± 23 months, the rate of major adverse limb events (MALE) was 30%; only the rate of major amputation between two groups was significant statistically different (p = .006). Group 1 had significantly lower amputation rate at 36 months (p = .01). The presence of high iliac peripheral artery calcium scoring system (PACCS) grade (HR 9.43, 95% CI 2.40–36.9, p = .001), the poor run-off of leg vessels (HR 0.15, 95% CI 0.02–0.92, p = .04), and undergoing CFA endarterectomy combined with outflow endovascular revascularization procedure (HR 4.25, 95% CI 1.07–16.89, p = .04) were independent predictors of PP loss, while severe iliac artery stenosis (OR 0.09, 95% CI 0.02–0.32, p = <.001) and the presence of pre-operative patent leg vessels (OR 8.03, 95% CI 2015–29.95, p = .002) were the significant independent predictors of LCI.

Conclusion

The use of hybrid first line approach in patients with CLTI is a safe and feasible technique. From the analysis of the current study, it is clear that any effort should be made to achieve as many patency leg vessels as possible in order to obtain better and longer lasting clinical outcomes.

Keywords

Peripheral artery disease chronic limb threatening ischemia hybrid surgery outcomes.

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References

Stoner

Calligaro

Chaer

, et al. Reporting standards of the society for vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg 2016; 64: e1–e21.

Aboyans

Ricco

Bartelink

MEL

, et al. Editor’s choice - 2017 ESC guidelines on the giagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS). Eur J Vasc endovascular Surg : official J Eur Soc Vasc Surg 2017; 55: 305–368.

Conte

Bradbury

Kolh

, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg 2019; 69: 3S–125S.

Antoniou

Sfyroeras

Karathanos

, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc endovascular Surg (2009); 38: 616–622.

Stavroulakis

Borowski

Torsello

CRITISCH Collaborators , et al. One-year results of first-line treatment strategies in patients with critical limb ischemia (CRITISCH Registry). J Endovascular Ther 2018; 25: 320–329.

Fowkes

Rudan

, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329–1340.

Rocha-Singh

Zeller

Jaff

. Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications. Catheterization Cardiovasc Interventions 2014; 83: E212–E220.

Rutherford

Baker

Ernst

, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26(3): 517–538.

Mezzetto

Mastrorilli

Abatucci

, et al. Impact of cone beam computed tomography in advanced endovascular aortic aneurysm repair using last generation 3D C-arm. Ann Vasc Surg 2021; 21: S0890–S5096. DOI: 10.1016/j.avsg.2021.04.035 Epub ahead of print.

10.

D’Oria

Griselli

Mastrorilli

, et al. Secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant siameter mismatch in the aorto-iliac territory. Vascular 2021; 29(2): 207–212. DOI: 10.1177/1708538120945056.

11.

Almasri

Adusumalli

Asi

, et al. A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. J Vasc Surg 2018; 68(2): 624–633.

12.

Veraldi

Mezzetto

Macrì

, et al. Comparison of endovascular versus bypass surgery in femoropopliteal TASC II D lesions: a single-center study. Ann Vasc Surg 2018; 47: 179–187.

13.

Torres-Blanco

Edo-Fleta

Gómez-Palonés

, et al. Mid-term outcomes of endovascular treatment for TASC-II D femoropopliteal occlusive disease with critical limb ischemia. Cardiovasc Intervent Radiol 2016; 39: 344–352.

14.

Baril

Chaer

Rhee

, et al. Endovascular interventions for TASC II D femoropopliteal lesions. J Vasc Surg 2010; 51: 1406–1412.

15.

Kuma

Tanaka

Ohmine

, et al. Clinical outcome of surgical endarterectomy for common femoral artery occlusive disease. Circ J 2016; 80: 964–969.

16.

Boufi

Ejargue

Gaye

, et al. Systematic review and meta-analysis of endovascular versus open repair for common femoral artery atherosclerosis treatment. J Vasc Surg 2021; 73(20): 1445–1455. DOI: 10.1016/j.jvs.2020.10.026 Epub ahead of print.

17.

Aho

Venermo

. Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg : SJS 2012; 101: 107–113.

18.

Takayama

Matsumura

. Complete lower extremity revascularization via a hybrid procedure for patients with critical limb ischemia. Vasc Endovasc Surg 2018; 52: 255–261.

19.

Wieker

Schönefeld

Osada

, et al. Results of common femoral artery thromboendarterectomy evaluation of a traditional surgical management in the endovascular era. J Vasc Surg 2016; 64: 995–1001.

20.

Dosluoglu

Lall

Cherr

, et al. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg 2010; 51: 1425–1435.e1.

21.

Bodewes

TCF

Pothof

Darling

, et al. Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia. J Vasc Surg 2017; 66(6): 1775–1785.

22.

Musallam

Tamim

Richards

, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. The Lancet 2011; 378: 1396–1407.

23.

Toor

Jaumdally

Moss

, et al. Preprocedural hemoglobin predicts outcome in peripheral vascular disease patients undergoing percutaneous transluminal angioplasty. J Vasc Surg 2009; 50: 317–321.

24.

Sigvant

Lundin

Wahlberg

. The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease. Eur J Vasc Endovascular Surg 2016; 51(3): 395–403. DOI: 10.1016/j.ejvs.2015.10.022.

25.

Elbadawy

Ali

Saleh

. Midterm outcomes of common femoral endarterectomy combined with inflow and outflow endovascular treatment for chronic limb threatening ischaemia. Eur J Vasc Endovascular Surg 2020; 59(6): 947–955. DOI: 10.1016/j.ejvs.2020.02.028 Epub 2020 Mar 27. PMID: 32224037.

26.

Powell

Fillinger

Walsh

, et al. Predicting outcome of angioplasty and selective stenting of multisegment iliac artery occlusive disease. J Vasc Surg 2000; 32: 564–569.

27.

Chang

Goodney

Baek

, et al. Long-term results of combined common femoral endarterectomy and iliac stenting/stent grafting for occlusive disease. J Vasc Surg 2008; 48: 362–367.

28.

Smolock

Anaya-Ayala

El-Sayed

, et al. Clinical efficacy of concomitant tibial interventions associated with superficial femoral artery interventions in critical limb ischemia. J Vasc Surg (2013); 57: 19–27.

29.

Pavé

Benadiba

Berger

, et al. Below-the-knee angioplasty for critical limb ischemia: results of a series of 157 procedures and impact of the angiosome concept. Ann Vasc Surg 2016; 36: 199–207.

30.

Taurino

Persiani

Fantozzi

, et al. Trans-Atlantic inter-society consensus II C and D iliac lesions can be treated by endovascular and hybrid approach: a single-center experience. Vasc endovascular Surg 2014; 48: 123–128.

31.

Davies

Saad

Peden

, et al. Percutaneous superficial femoral artery interventions for claudication--does runoff matter?. Ann Vasc Surg 2008; 22: 790–798.

32.

Mills

Sr Conte

Armstrong

, et al. The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg 2014; 59(1): 220–234e1.

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Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia