Hybrid Endovascular and Open Treatment of Severe Multilevel Lower Extremity Arterial Disease

Abstract

Objective: To evaluate the feasibility and efficacy of simultaneous combined endovascular and open tower extremity arterial reconstruction. Design: Case series study with retrospective analysis of prospectively collected non-randomised data. Methods: Patients were divided into three groups: group 1 and group 2 included patients who underwent endovascular reconstruction proximal and distal to the site of open reconstruction, respectively, whereas group 3 included patients who underwent open surgery with both proximal and distal endoluminal procedures. Patency analyses were performed using Kaplan-Meier life tables. Univariate and multivariate analyses were used to assess the influence of various risk factors on primary patency. Results: Complete data were obtained from 60 patients who underwent 61 single-step hybrid procedures. Technical and haemodynamic success rates were 100% and 95%, respectively. The perioperative mortality rate was 3%. The primary and assisted-primary patency rates at 12 months were 71% and 98%, respectively. Primary patency rates were lower in group 3 when compared with groups 1 and 2 (log-rank test, p = 0.006). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency (p = 0.003 and p = 0.014, respectively). Conclusions: Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease. The extent of the disease, diabetes and dyslipidaemia are associated with worse outcome. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.