title: Hybrid procedures for chronic lower limb ischemia: what determines the outcome?
abstract: BACKGROUND
  To report the long term outcome of hybrid (combined open and endovascular) procedures for the management of multisegmental chronic peripheral arterial disease.
  
  
  METHODS
  A retrospective analysis from a single center during the period 2009-2013. Patency rates, survival and limb salvage were the primary outcomes. Univariate and multivariate analyses were used to assess the association with various factors.
  
  
  RESULTS
  A total of 132 patients (116 males) with mean age of 69±1.4 years, were treated. The technical and hemodynamic success rates were 94% and 97.7% respectively. The primary and assisted primary patency rates in 36 months were 69.7% and 94.7%, respectively. The Hazard Ratio for primary and assisted primary patency failure was 1.94 (95% CI: 1.07-3.51, P=0.029) and 5.55 (95% CI: 1.15-26.79, P=0.033) times higher in diabetic patients, respectively. Limb salvage rate in 36 months was 87.9%. Rutherford category (P=0.046) and previous ipsilateral reconstruction (P=0.011) were the only factors associated with limb loss.
  
  
  CONCLUSIONS
  Hybrid procedures are associated with good long term outcomes in the treatment of multisegmental chronic peripheral arterial disease. Diabetes mellitus remains a determinant of worse outcome, while the severity of the disease and previous ipsilateral revascularization are associated with poorer limb salvage.
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece - spanos.kon@gmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spanos
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Saleptsis
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Athanasoulas
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Drakou
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Koutsias
authors.affiliation: Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017130:Angioplasty / Q000009:adverse effects; D048909:Diabetes Complications / Q000453:epidemiology; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D023821:Limb Salvage / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D014654:Vascular Patency