title: [Hybrid surgical and endovascular therapy in TASC type D atherosclerotic occlusive disease: a retrospective analysis of 48 cases].
abstract: OBJECTIVE
  to retrospectively analyze 4-year results after hybrid (combined surgical-endovascular) therapy in patients with complex peripheral TASC type D atherosclerotic occlusive disease.
  
  
  METHODS
  from January 2006 to December 2009, 48 lower limbs in 46 patients with TASC type D atherosclerotic occlusive disease were treated by hybrid surgical and endovascular therapy. There were 32 male and 16 female, age ranged from 54 to 85 years with an average of 67 years. The early clinical results were determined by ankle brachial index (ABI) and intermittent claudication distance. 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
  all lower limbs underwent successful hybrid surgical and endovascular therapy. The average ABI before and after hybrid therapy were 0.63 ± 0.18 and 0.24 ± 0.13 (P < 0.05). The average intermittent claudication distance significantly increased from (87 ± 48) m to (247 ± 62) m (P < 0.05). The mean duration of follow-up was 21.7 months (ranging 1 to 46 months). Over all, the primary patency rates, primary assisted patency rates and second patency rates were 79.2%, 83.3% and 95.8% respectively. The primary patency rate for intermittent claudication was significantly higher than that for critical limb ischemia (P < 0.05). Primary patency rates were lower in patients who underwent open surgery with both proximal and distal endoluminal procedures when compared with endovascular reconstruction proximal or distal to the site of open reconstruction (P < 0.05). The presence of diabetes and dyslipidaemia were independent predictors of decreased primary patency rate (P = 0.013 and P = 0.008, respectively).
  
  
  CONCLUSIONS
  Hybrid procedures provide an effective treatment management of selected patients with multilevel lower extremity arterial disease.
authors.affiliation: Department of Vascular and Endovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.forename: Chang-Jian
authors.initials: CJ
authors.lastname: Liu
authors.forename: Tong
authors.initials: T
authors.lastname: Qiao
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.forename: Dian
authors.initials: D
authors.lastname: Huang
authors.forename: Feng
authors.initials: F
authors.lastname: Ran
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome