title: Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease.
abstract: OBJECTIVE
  To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases.
  
  
  METHODS
  Case series study with retrospective analysis of prospectively collected nonrandomized data.
  
  
  METHODS
  Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan-Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency.
  
  
  RESULTS
  HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P<0.001, respectively), and the presence of diabetes and renal insufficiency were another two independent predictors of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively).
  
  
  CONCLUSIONS
  Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency.
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Dian
authors.initials: D
authors.lastname: Huang
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Tong
authors.initials: T
authors.lastname: Qiao
authors.affiliation: Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Chang-Jian
authors.initials: CJ
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000628:therapy; D004691:Endarterectomy; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*
keywords: atherosclerotic occlusive disease; endovascular treatment; hybrid procedure