Surgical and endovascular hybrid approach in peripheral arterial disease of the lower limbs.
BACKGROUND
Multilevel peripheral arterial disease is frequently observed in patients with intermittent claudication or critical limb ischemia. This report evaluates the efficacy of one-stage hybrid revascularization in patients with multilevel arterial peripheral disease.


METHODS
A retrospective analysis of a prospective database included all consecutive patients treated by a hybrid approach for a multilevel arterial peripheral disease. The primary outcome was the patency rate at 6 months and 1 year. Secondary outcomes were early and midterm complication rate, limb salvage and mortality rate. Statistical analysis, including a Kaplan-Meier estimate and univariate and multivariate Cox regression analyses were carried out with the primary, primary assisted and secondary patency, comparing the impact of various risk factors in pre- and post-operative treatments.


RESULTS
64 patients were included in the study, with a mean follow-up time of 428 days (range: 4 - 1140). The technical success rate was 100 %. The primary, primary assisted and secondary patency rates at 1 year were 39 %, 66 % and 81 %, respectively. The limb-salvage rate was 94 %. The early mortality rate was 3.1 %. Early and midterm complication rates were 15.4 % and 6.4 %, respectively. The early mortality rate was 3.1 %.


CONCLUSIONS
The hybrid approach is a major alternative in the treatment of peripheral arterial disease in multilevel disease and comorbid patients, with low complication and mortality rates and a high limb-salvage rate.
1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Anouk
A
Grandjean
1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Katia
K
Iglesias
1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Céline
C
Dubuis
1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Sébastien
S
Déglise
1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Jean-Marc
JM
Corpataux
1 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
François
F
Saucy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016638:Critical Illness; D016208:Databases, Factual; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000401:mortality; D014654:Vascular Patency
Hybrid approach; combined approach; critical limb ischemia; intermittent claudication; multilevel peripheral arterial disease