1
|
Walker H, Chana MS, Mandalia K, Kulkarni SR, Paravastu SCV. Observational Study on the Risk of Surgical Site Infection in Patients Undergoing Common Femoral Endarterectomy in Conjunction With an Endovascular Procedure Compared With Common Femoral Endarterectomy Alone. EJVES Vasc Forum 2024; 61:116-120. [PMID: 38884070 PMCID: PMC11177046 DOI: 10.1016/j.ejvsvf.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024] Open
Abstract
Objective A hybrid approach is being employed increasingly in the management of peripheral arterial disease. This study aimed to assess the surgical site infection (SSI) incidence of hybrid revascularisation (HR) compared with common femoral endarterectomy (CFEA) alone. Methods This was a retrospective review of consecutive patients who underwent CFEA or HR alongside CFEA between 2017 and 2021 including one year of follow up. The primary outcome was SSI incidence. Secondary outcomes included length of surgery, duration of admission, further revascularisation surgery, limb salvage, and death. Differences in outcomes were assessed with the Student's unpaired t test, chi square test, and Fisher's exact test. Results A total of 157 groin incisions from 155 patients were included: 78 had CFEA procedures and 79 had HR procedures. No statistical difference was found between groups for age, sex, and indication for surgery. Surgical site infection occurred in five of the CFEA patients (6%) compared with seven of the HR patients (9%) (p = 0.77). The HR procedures took significantly longer, with an average of 299 minutes compared with 220 minutes for CFEA (p < 0.001). No statistically significant difference was identified for length of admission: median stay five days for CFEA vs. four days for HR (p = 0.44). Major amputation was performed within one year in five of the CFEA procedures (6%) and five of the HR procedures (6%) (p = 1.0). Further revascularisation surgery was attempted in two patients in the HR group and six patients in the CFEA group (p =. 17). No statistically significant difference was found in the one year mortality rate: eight CFEA (10%) and seven HR (9%) (p = 0.77). Conclusion Patients who underwent HR alongside CFEA did not have a statistically significantly increased incidence of SSI, despite increased surgical time. Using HR techniques enabled patients to have multilevel disease treated in one stage without an increased incidence of SSI.
Collapse
Affiliation(s)
- Hamish Walker
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Manik S Chana
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Kavisha Mandalia
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | - Sachin R Kulkarni
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom
| | | |
Collapse
|
2
|
Fataliev GB, Arakelian VS, Shubin AA. [Hybrid operations in treatment of patients with multi-level lesions of lower limb arteries]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:173-179. [PMID: 34528603 DOI: 10.33529/angiq2021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The article is a review of literature dedicated to simultaneous open and endovascular (hybrid) operations in treatment of patients with chronic ischaemia of lower limbs. Despite good results of endovascular interventions, in many situations involvement of arteries below the inguinal fold and multilevel lesions are arguments in favour of performing an open operation. On the other hand, open multilevel interventions are accompanied by an increased risk of complications and mortality. Hybrid interventions appear to be a safe and efficient alternative combining advantages of two methods of treatment and making it possible to achieve an optimal outcome with a minimal surgical wound. Also discussed herein are the problems of terminology, indications for, techniques and results of treatment, providing a historical background, followed by analysing problem spots of using this technique and trends of development.
Collapse
Affiliation(s)
- G B Fataliev
- Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department, Moscow, Russia
| | - V S Arakelian
- A.N.Bakulev National Medical Research Center of Cardiovascular Surgery of the RF Ministry of Public Health, Moscow, Russia
| | - A A Shubin
- Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department, Moscow, Russia
| |
Collapse
|
3
|
Osipova O, Cheban A, Ignatenko P, Ruzankin P, Prokopenko E, Karpenko A. The effect of the stented iliac lesions TASC-II C, D on the femoropopliteal bypass patency: Propensity score-matched observational study. Vasc Med 2021; 27:230-238. [PMID: 34269143 DOI: 10.1177/1358863x211021165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Concurrent stenting of complex iliac lesions during infrainguinal bypasses can increase the complexity of a case and impact outcomes. OBJECTIVE Our aim was to evaluate the effect of inflow stenting of TASC-II C, D iliac lesions on femoropopliteal bypass patency. METHODS A retrospective observational cohort study of patients who underwent femoropopliteal bypass with TASC-II C, D iliac artery stenting (hybrid group) or without inflow lesions (non-hybrid group) was conducted. After propensity score matching, 120 patients were included in the non-hybrid group and 60 patients in the hybrid one. The median follow-up was 432 (193; 1313) days in the hybrid group and 472 (196; 1376) days in the non-hybrid group (p = 0.94). RESULTS No significant differences were found between the groups in 30-day morbidity and serious adverse events. At 3 years, primary and secondary bypass patency for the hybrid group and non-hybrid group were 62.2% versus 59.9% (p = 0.36) and 63.7% versus 64.3% (p = 0.077), respectively. The primary patency of the iliac stents in patients of the hybrid group was 95% at 3 years. The estimated hazard ratio for primary patency for hybrid versus non-hybrid was 0.77, with 90% CI: 0.50-1.21; the noninferiority upper bound being 1.31, which corresponds to a 10% additive noninferiority margin for probabilities. The 3 years of freedom from amputation in patients with chronic limb-threatening ischemia was 94.1% and 75.0% in the hybrid and non-hybrid groups, respectively (p = 0.09). CONCLUSION The outcomes of the femoropopliteal bypass in hybrid surgery supplemented with stenting of TASC-II C, D iliac lesions was similar to femoropopliteal bypass with intact inflow arteries.
Collapse
Affiliation(s)
- Olesia Osipova
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Alexey Cheban
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Pavel Ignatenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Pavel Ruzankin
- Sobolev Institute of Mathematics, Novosibirsk, Russia.,Department of Probability Theory and Mathematical Statistics, Novosibirsk State University, Novosibirsk, Russia
| | - Evgeny Prokopenko
- Sobolev Institute of Mathematics, Novosibirsk, Russia.,Department of Probability Theory and Mathematical Statistics, Novosibirsk State University, Novosibirsk, Russia
| | - Andrey Karpenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| |
Collapse
|
4
|
Giusti JCG, Cury MVM, Rossi FH, Soares SP, Trento AF, Tartarotti SP, Brochado-Neto FC. Eversion Endarterectomy of the External Iliac Artery in Treating Chronic Limb-Threatening Ischemia in TASC II C and D Iliofemoral Occlusive Disease. Ann Vasc Surg 2021; 75:162-170. [PMID: 33556512 DOI: 10.1016/j.avsg.2021.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endovascular treatment of iliofemoral occlusive disease is a challenging approach, especially for TransAtlantic Inter-Society C and D lesions. Therefore, the revascularization procedure in such situations is preferably performed by bypass graft surgery with synthetic materials. The purpose of this study is to report the feasibility and mid-term results of eversion endarterectomy of the external iliac artery (EEEIA), as an alternative autologous option. METHODS Retrospective study with 18 EEEIA performed between September 2015 and February 2020, exclusively for chronic limb-threatening ischemia treatment in patients with increased risk of postoperative surgical infection and inadvisable for endovascular treatment. Demographic, clinical variables and outcomes were collected from a prospective database. The main end points are: amputation-free survival (AFS) and 30-day mortality. Secondary end points include: primary patency (PP), cumulative patency (CP), overall survival (OS), and postoperative surgical complication. Kaplan-Meier analysis was used to estimate cumulative time of outcomes. RESULTS The mean age was 64.8 ± 8.3 years, with predominance of men. The median follow-up period was 1012 days, 95% confidence interval [119, 1365] days. Most had Rutherford 5 (n = 13, 72.2%) and mean ankle brachial index was 0.38 ± 0.22. The PP, CP, AFS, and OS in 730 days were 81%, 92%, 80%, and 88%, respectively. There was no 30-day mortality or postoperative surgical infection. CONCLUSIONS Iliofemoral reconstruction through EEEIA is an effective surgical procedure with good patency rates, AFS and OS. In addition, it can be considered an useful and safe option, especially in cases in which a prosthesis should be avoided.
Collapse
Affiliation(s)
- Júlio César Gomes Giusti
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil.
| | - Marcus Vinícius Martins Cury
- Department of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
| | - Fábio Henrique Rossi
- Department of Vascular and Endovascular Surgery, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
| | - Samara Pontes Soares
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil
| | - André Felipe Trento
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil
| | - Sabrina Payne Tartarotti
- Department of Vascular Surgery, Hospital Municipal Dr Carmino Caricchio, Tatuapé, São Paulo, São Paulo, Brazil
| | | |
Collapse
|
5
|
Fereydooni A, Zhou B, Xu Y, Deng Y, Dardik A, Ochoa Chaar CI. Rapid increase in hybrid surgery for the treatment of peripheral artery disease in the Vascular Quality Initiative database. J Vasc Surg 2020; 72:977-986.e1. [DOI: 10.1016/j.jvs.2019.11.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/18/2019] [Indexed: 12/26/2022]
|
6
|
Mustapha JA, Anose BM, Martinsen BJ, Pliagas G, Ricotta J, Boyes CW, Lee MS, Saab F, Adams G. Lower extremity revascularization via endovascular and surgical approaches: A systematic review with emphasis on combined inflow and outflow revascularization. SAGE Open Med 2020; 8:2050312120929239. [PMID: 32551113 PMCID: PMC7278295 DOI: 10.1177/2050312120929239] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/03/2020] [Indexed: 11/15/2022] Open
Abstract
This review is intended to help clinicians and patients understand the present state of peripheral artery disease, appreciate the progression and presentation of critical limb ischemia/chronic limb-threatening ischemia, and make informed decisions regarding inflow and outflow endovascular revascularization and surgical treatment options within the context of current debates in the medical community. A controlled literature search was performed to obtain research on outcomes of critical limb ischemia patients undergoing complete leg revascularization for peripheral artery disease inflow and outflow disease. Data for this review were identified by queries of medical and life science databases, expert referral, and references from relevant papers published between 1997 and 2019, resulting in 48 articles. The literature review herein indicates that endovascular revascularization-including ballooning, stenting, and atherectomy-is an effective peripheral artery disease therapy for both above the knee and below the knee disease, and can safely and effectively treat both inflow and outflow disease. As such, it plays a leading role in the therapy of lower extremity artery disease.
Collapse
Affiliation(s)
| | - Bynthia M Anose
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Brad J Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - George Pliagas
- Vascular Division, Premier Surgical Associates, Knoxville, TN, USA
| | - Joseph Ricotta
- Tenet Florida Cardiovascular Care, Delray Beach, FL, USA
| | - Christopher W Boyes
- Carolinas Medical Center and Sanger Heart & Vascular Institute, Vascular Surgery, Charlotte, NC, USA
| | | | - Fadi Saab
- Advanced Cardiac & Vascular Centers, Grand Rapids, MI, USA
| | - George Adams
- North Carolina Heart and Vascular, Rex Hospital, UNC School of Medicine, Raleigh, NC, USA
| |
Collapse
|
7
|
Midterm Outcomes of Common Femoral Endarterectomy Combined with Inflow and Outflow Endovascular Treatment for Chronic Limb Threatening Ischaemia. Eur J Vasc Endovasc Surg 2020; 59:947-955. [PMID: 32224037 DOI: 10.1016/j.ejvs.2020.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess mid term outcomes of common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with chronic limb threatening ischaemia (CLTI). METHODS This was a prospective study. All patients who, for the first time, underwent planned one stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularisation procedure to achieve limb salvage in patients with CLTI due to multilevel disease were included between January 2015 and May 2017. Demographics, and clinical and lesion characteristics for each patient were reported. The primary outcome was primary patency. Secondary outcomes were technical success, peri-operative morbidity and mortality, assisted primary patency, secondary patency, clinically driven target lesion revascularisation and amputation free survival. RESULTS Three groups were created according to the endovascular treatment zone: group 1 (inflow, n = 60); group 2 (outflow, n = 46); and group 3 (combined inflow and outflow, n = 53). CFA endarterectomy was a fixed step in all cases. The overall technical success was 98%. The peri-operative complication rate was 14% and the mortality rate was 2%. Patients in group 3 demonstrated a significantly lower primary patency rate (53.9% ± 7.1%; p < .001) at 24 months but improved secondary patency rate of (94.0% ± 3.4%). Based on the outcomes of the Cox regression multivariable analysis, lesion length (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.06-1.14; p < .001), chronic total occlusion (CTO) (HR 0.50, 95% CI 0.25-0.98; p = .046), peripheral artery calcium scoring system (PACSS) grade 4 (HR 2.44, 95% CI 1.27-4.68; p = .008), incomplete revascularisation (HR 3.32, 95% CI 1.64-6.73; p = .001), and dyslipidaemia (HR 0.50, 95% CI 0.27-0.93; p = .031) were the only significant independent predictors of loss of primary patency. CONCLUSION Common femoral endarterectomy combined with an inflow and outflow endovascular revascularisation procedure in patients with CLTI is safe, with acceptable patency rates, despite the need for secondary interventions. Dyslipidaemia, lesion length, CTO, PACSS grade 4, and incomplete revascularisation are independent predictors of primary patency loss. The current study analysis supports the recommendation to stage the procedure based on patient risk and degree of limb threat.
Collapse
|
8
|
Hybrid Surgery in Lower Limb Revascularization: A Real-World Experience from a Single Center. Ann Vasc Surg 2019; 60:355-363. [DOI: 10.1016/j.avsg.2019.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 01/22/2023]
|
9
|
Hybrid surgery for bilateral lower extremity inflow revascularization. J Vasc Surg 2019; 70:768-775.e2. [PMID: 30837177 DOI: 10.1016/j.jvs.2018.11.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Aortobifemoral (ABF) bypass is the preferred method of bilateral inflow revascularization, with axillobifemoral (AXBF) bypass reserved for high-risk patients. Hybrid (HYB) surgery in the form of femorofemoral bypass and retrograde endovascular aortoiliac intervention is increasingly being used to achieve the same goal. This study compared the perioperative outcomes of HYB surgery with traditional surgery for bilateral inflow revascularization. METHODS The American College of Surgeons National Surgical Quality Improvement Program files for the years 2012 to 2015 were reviewed, and all patients undergoing ABF bypass, AXBF bypass, and HYB surgery (femoral-femoral bypass and retrograde endovascular intervention) were included. Patients' demographics, comorbidities, and outcomes were compared between the three groups. A propensity-matched analysis was subsequently performed to compare HYB surgery with ABF bypass only. The χ2 test and analysis of variance with post hoc analysis were conducted to evaluate between-group differences in risk factors and outcomes. SPSS statistical software (IBM Corp, Armonk, NY) was used. RESULTS There were 1426 patients (ABF bypass, 976; AXBF bypass, 257; HYB surgery, 193). There were significant differences in the three populations of patients, with ABF bypass patients significantly more likely to have age <70 years (ABF bypass, 84.2%; AXBF bypass, 49.8%; HYB surgery, 58%; P < .001) and more likely to be independent (ABF bypass, 98%; AXBF bypass, 89.1%; HYB surgery, 93.2%; P < .001). Patients undergoing AXBF bypass were significantly more likely to be treated for critical limb ischemia (ABF bypass, 46.5%; AXBF bypass, 72.4%; HYB surgery, 51.8%; P < .001) under emergent conditions (ABF bypass, 0.9%; AXBF bypass, 5.1%; HYB surgery, 3.6%; P < .001). There was no difference in mortality between the three groups (P = .178). After propensity matching, a total of 571 patients with ABF bypass were compared with HYB surgery patients. HYB surgery patients had significantly less pneumonia (ABF bypass, 8.7%; HYB surgery, 1.6%; P < .001), unplanned intubation (ABF bypass, 7.7%; HYB surgery, 3.1%; P = .032), cardiac arrest (ABF bypass, 3.7%; HYB surgery, 0.5%; P = .025), transfusion (ABF bypass, 44.4%; HYB surgery, 18.1%; P < .001), and composite morbidity (ABF bypass, 55%; HYB surgery, 32.6%; P < .001). Patients undergoing ABF bypass had significantly higher mortality (ABF bypass, 4.2%; HYB surgery, 1%; P = .043) and 30-day reoperation (ABF bypass, 17.5%; HYB surgery, 9.3%; P = .009) and longer total hospital length of stay (ABF bypass, 9.79 ± 10.69 days; HYB surgery, 5.79 ± 9.72 days; P < .001). There was no difference in major amputation (P = .607) and readmission (P = .495) between the two groups. CONCLUSIONS ABF bypass is the most common surgery for bilateral lower extremity revascularization in the American College of Surgeons National Surgical Quality Improvement Program database and continues to have good outcomes. In selected patients, HYB surgery was associated with improved perioperative, 30-day outcomes compared with ABF bypass.
Collapse
|
10
|
Jorshery SD, Skrip L, Sarac T, Ochoa Chaar CI. Hybrid femoropopliteal procedures are associated with improved perioperative outcomes compared with bypass. J Vasc Surg 2018; 68:1447-1454.e5. [DOI: 10.1016/j.jvs.2018.01.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/30/2018] [Indexed: 01/22/2023]
|
11
|
Langenberg JC, te Slaa A, de Groot HG, Ho GH, Veen EJ, Buimer TM, van der Laan L. Infection Risk Following Common Femoral Artery Endarterectomy Versus a Hybrid Procedure. Ann Vasc Surg 2018; 53:148-153. [DOI: 10.1016/j.avsg.2018.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 11/30/2022]
|
12
|
Lee SC, Joh JH, Chang JH, Kim HK, Kim JY, Park K, Hong KC, Byun SJ, Lee TS, Jung HJ, Lee SS. Hybrid treatment of multilevel revascularization in patients with peripheral arterial disease – a multi-centre study in Korea. VASA 2018; 47:235-241. [DOI: 10.1024/0301-1526/a000694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Endovascular treatment is an alternative first-line management for peripheral artery disease (PAD). Hybrid treatment (HT) is defined as a combined treatment for patients with PAD using endovascular and open surgery, simultaneously performed in an operating room. The results of HT are reportedly good for multilevel revascularization (MR) in patients with chronic limb ischaemia, and even in older high-risk patients. The goal of this study was to examine the clinical and haemodynamic outcomes of HT in patients who need MR. Patients and methods: Nine university hospitals in Korea participated in this multicentre study. A total of 134 patients with multilevel PAD underwent HT and MR. Patients were enrolled from July 2014 to June 2015 and were followed for 18 months. Results: The mean age of the patients was 68.8 ± 9.93 years and 88.1 % were men. Patients with Rutherford category 2 to 3 and 4 to 6 comprised 59.0 % and 42.0 % of the group, respectively. The technical success rate was 100 %. The primary patency rates at 12 and 18 months were 77.6 % and 63.9 %, respectively. The primary-assisted patency rates at 12 and 18 months were both 90.0 %. The pre-operative mean ankle brachial index (0.43 ± 0.23) increased to 0.87 ± 0.23 at six months post-operatively (t-test, p < 0.05). The amputation free survival rate was 97.1 %. Conclusions: Although outcomes of multilevel PAD are reportedly poor when endovascular treatment alone is used, we have shown that HT is a feasible alternative modality for patients with multilevel PAD, with satisfactory amputation-free survival and freedom from re-intervention rates.
Collapse
Affiliation(s)
- Soon Cheon Lee
- Department of Surgery, Gwangyang Sarang Hospital, Gwangyang, Republic of Korea
| | - Jin Hyun Joh
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwan Chang
- Department of Surgery, Chosun University College of Medicine and Cheondam Medical Center, Gwangju, Republic of Korea
| | - Hyung-Kee Kim
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jang Yong Kim
- Department of Surgery, Catholic University College of Medicine, Republic of Korea
| | - KiHyuk Park
- Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Republic of Korea
| | - Ki Chun Hong
- Department of Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seung Jae Byun
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Tae Seung Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Jae Jung
- Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and EndoVascular Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sang Su Lee
- Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and EndoVascular Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Republic of Korea
| |
Collapse
|
13
|
Sapienza P, Venturini L, Grande R, Scarano Catanzaro V, Gazzanelli S, Sterpetti AV, Tartaglia E. Is the Endovascular Treatment of Mild Iliac Stenoses Worthwhile to Improve Wound Healing in Patients Undergoing Femorotibial Bypass? Ann Vasc Surg 2017; 47:162-169. [PMID: 28890068 DOI: 10.1016/j.avsg.2017.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND After an infrapopliteal reconstruction, minor amputations are frequently required, but even in the case of successful revascularization, wound healing is a major concern. We studied the role of iliac artery inflow correction in patients undergoing infrapopliteal vein grafts to improve the heal of midfoot amputation. METHODS Thirty-eight patients affected with Rutherford grade III category 5 peripheral arterial disease, who underwent successful simultaneous iliac endovascular procedure, infrapopliteal reversed vein bypass graft, and minor amputation, were enrolled in this retrospective study. The population was divided in group 1 (20 patients) with inflow vessels Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) II type B atherosclerotic lesions and group 2 (18 patients) with TASC II type A atherosclerotic lesions determining an invasive pressure drop greater than 15 mm Hg. Fifteen patients (group 3) undergoing infrapopliteal reversed vein bypass graft without associated inflow procedures (TASC II type A and invasive pressure drop greater than 15 mm Hg) were matched with group 2 based on propensity score. Healing was calculated by subtracting the final ulcer area from the initial ulcer area and dividing by the number of follow-up months to obtain the total area healed per month (cm2/month). Stepwise logistic regression analysis adjusted for demographics and medical comorbid conditions was used to test the association between wound healing and treatment modalities. RESULTS Forty-three patients were available for further analysis. Ten patients were excluded because of graft occlusion with consequent impairment of wound healing. After midfoot amputations, mean wound diameter was 20 ± 8 cm2, and mean healing time was 10 ± 4 months (range 3-20 months; median 9 months). Wounds of groups 1 and 2 healed faster than those of group 3 at 4 and 8 months (P < 0.02 and P < 0.001, respectively; P < 0.04 and P < 0.001, respectively). Multivariate analysis demonstrated the association between wound healing and inflow correction (P < 0.001). CONCLUSIONS An aggressive treatment is necessary to obtain the heal of the ischemic wounds. The most important predictive factor for nonhealing wounds is the absence of inflow correction. We demonstrated that the inflow should be also corrected in the presence of subclinical lesions.
Collapse
Affiliation(s)
- Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy.
| | - Luigi Venturini
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Grande
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | | | - Sergio Gazzanelli
- Department of Anesthesiology, Intensive Care and Pain Therapy, "Sapienza" University of Rome, Rome, Italy
| | - Antonio V Sterpetti
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Elvira Tartaglia
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Le Raincy-Montfermail, Paris, France
| |
Collapse
|
14
|
Nishibe T, Maruno K, Iwahori A, Fujiyoshi T, Suzuki S, Takahashi S, Ogino H, Nishibe M. The Role of Common Femoral Artery Endarterectomy in the Endovascular Era. Ann Vasc Surg 2015; 29:1501-7. [DOI: 10.1016/j.avsg.2015.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/04/2015] [Accepted: 05/04/2015] [Indexed: 11/28/2022]
|
15
|
The 9th Japan-Korea Joint Meeting for Vascular Surgery. Ann Vasc Dis 2015; 8:144-86. [PMID: 26150901 DOI: 10.3400/avd.jk.15-01000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Argyriou C, Georgiadis GS, Mantatzis M, Schoretsanitis NG, Antoniou GA, Papadopoulou MZ, Vogiatzaki T, Lazarides MK. Hybrid reconstruction of the upper limb in a patient with chronic limb ischemia. Vascular 2014; 23:653-6. [PMID: 25403572 DOI: 10.1177/1708538114560459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Hybrid vascular interventions performed in patients with chronic limb ischemia are considered minimally invasive techniques for treating complex multilevel arterial occlusive disease. METHODS We report the case of a 42-year-old woman with a critical upper limb ischemia, who underwent angioplasty and secondary stenting of the distal-third of the axillary artery followed by a brachial-brachial bypass using an autologous graft. RESULTS The patient had an uneventful recovery. To our knowledge, this is the first case reported in the literature of hybrid vascular reconstruction in the upper limb due to atherosclerosis. CONCLUSION Hybrid revascularization procedure in the upper limb is technically feasible, safe for the patient, and should become a part of the armamentarium of the modern vascular surgeon.
Collapse
Affiliation(s)
- Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Michael Mantatzis
- Department of Radiology, Interventional Radiology Unit, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Nikolaos G Schoretsanitis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - George A Antoniou
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Maria Z Papadopoulou
- Department of Anesthesiology, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Theodosia Vogiatzaki
- Department of Anesthesiology, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Alexandroupolis, Greece
| |
Collapse
|
17
|
Zhou M, Huang D, Liu C, Liu Z, Zhang M, Qiao T, Liu CJ. Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease. Clin Interv Aging 2014; 9:1595-603. [PMID: 25284992 PMCID: PMC4181442 DOI: 10.2147/cia.s66860] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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. Design 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). Conclusion 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.
Collapse
Affiliation(s)
- Min Zhou
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Dian Huang
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Chen Liu
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Zhao Liu
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Min Zhang
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Tong Qiao
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| | - Chang-Jian Liu
- Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People's Republic of China
| |
Collapse
|
18
|
Hybrid endarterectomy and endovascular therapy in multilevel lower extremity arterial disease involving the femoral artery bifurcation. Int Surg 2014; 97:56-64. [PMID: 23102001 DOI: 10.9738/0020-8868-97.1.56] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to evaluate the feasibility and efficacy of hybrid therapy (combined endarterectomy-endovascular) in patients with complex peripheral multifocal steno-obstructive vascular disease involving the femoral artery bifurcation. Forty-one combined procedures were performed on 40 patients. Although the common femoral artery was usually treated with endarterectomy, endoluminal procedures were performed proximally in 12 patients (group 1), distally in 18 patients (group 2), and both upward and downward in 11 patients (group 3). Patients underwent clinical assessment and ankle-brachial index measurement thereafter. Primary, assisted-primary, and secondary patency rates at 24 months were 59%, 66%, and 72%, respectively. Primary patency rates were lower in group 3 compared with groups 1 and 2 (P = 0.015). The limb salvage rate was 86.4% at the end of the follow-up period. Hybrid procedures provide feasible and effective treatment management of selected patients with multilevel lower extremity arterial disease involving the femoral artery bifurcation.
Collapse
|
19
|
Argyriou C, Georgakarakos E, Georgiadis GS, Antoniou GA, Schoretsanitis N, Lazarides M. Hybrid Revascularization Procedures in Acute Limb Ischemia. Ann Vasc Surg 2014; 28:1456-62. [DOI: 10.1016/j.avsg.2014.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
|
20
|
Abstract
Hybrid interventions have become an integral part of our strategy for limb salvage in patients with multilevel arterial occlusive disease. In this article, we describe the commonly used hybrid interventions and review their indications and outcomes. Iliac stenting and femoral endarterectomy are the two most frequently performed procedures in hybrid cases. Short- and long-term outcomes of hybrid interventions are at least comparable to conventional endovascular and surgical revascularization procedures. Hybrid revascularization offers the efficiency and convenience of a single-stage revascularization.
Collapse
Affiliation(s)
- Tam T T Huynh
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | |
Collapse
|
21
|
Davies RSM, Adair W, Bolia A, Fishwick G, Sayers RD, McCarthy MJ. Endovascular Treatment of the Common Femoral Artery for Limb Ischemia. Vasc Endovascular Surg 2013; 47:639-44. [DOI: 10.1177/1538574413500723] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the short- and mid-term outcomes of percutaneous endovascular common femoral artery (CFA) revascularization (eCFR) of the CFA. Methods: A review of patients who underwent eCFR for limb ischemia between 2006 and 2012 was performed. Limb salvage, patient survival, survival free from reintervention, and survival free from amputation rates were determined. Median (range) follow-up was 28 (1-71) months. Results: In all, 115 patients underwent 121 eCFR for CFA occlusion (n = 13) or stenosis (n = 108); 109 (90%) were technically successful and 7 (6%) had significant perioperative complications; access site hematoma (n = 2) and thromboembolism (n = 5). Thirty-day mortality and amputation rates were 2.5% and 0.8%, respectively. The 1- and 3-year limb salvage rates were 97% and 97%, respectively. The 1- and 3-year survival free from reintervention rates were 77% and 57%, respectively. The 1- and 3-year survival free from amputation rates were 84% and 70%, respectively. Conclusion: These novel data demonstrate that eCFR is a durable treatment for patients with limb ischemia associated with CFA disease.
Collapse
Affiliation(s)
- Robert S. M. Davies
- Department of Radiology, Leicester Royal Infirmary, Leicester, UK
- Department of Vascular Surgery, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK
| | - William Adair
- Department of Radiology, Leicester Royal Infirmary, Leicester, UK
| | - Amman Bolia
- Department of Radiology, Leicester Royal Infirmary, Leicester, UK
| | - Guy Fishwick
- Department of Radiology, Leicester Royal Infirmary, Leicester, UK
| | - Robert D. Sayers
- Department of Vascular Surgery, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK
| | - Mark J. McCarthy
- Department of Vascular Surgery, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK
| |
Collapse
|
22
|
Joh JH, Joo SH, Park HC. Simultaneous hybrid revascularization for symptomatic lower extremity arterial occlusive disease. Exp Ther Med 2013; 7:804-810. [PMID: 24669236 PMCID: PMC3961109 DOI: 10.3892/etm.2014.1513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 01/13/2014] [Indexed: 11/06/2022] Open
Abstract
Multilevel revascularization, using a combination of endovascular and open (hybrid) surgery, is increasingly being used. Hybrid surgery allows complex anatomy to be treated by minimally invasive procedures in medically high risk patients. The aim of the present study was to report a novel hybrid surgery for lesions in the multilevel lower extremity arteries and to evaluate the clinical outcomes. Consecutive patients who presented at a single institution between March 2009 and Feburary 2012 were selected for inclusion in the study. The patients had disabling claudication or critical limb ischemia and underwent treatment for revascularization by open surgery or by a combination of open surgery and endovascular procedure. Retrospective analysis was conducted from a prospectively collected database. All procedures were performed by a vascular surgeon in an operating room. Postoperative surveillance in outpatient clinics was conducted at 3 and 6 months and every 6 months thereafter. A total of 76 patients were included in the study with a mean age of 67.1±11.3 years (range, 42-94 years) and the male to female ratio was 67:9. The most common indication for revascularization was Rutherford category IV (resting pain). The immediate technical success rate of hybrid surgery was 90.5%, with an overall limb salvage rate of 97.4%. The primary patency rates of the hybrid and open groups were 100 and 90.9%, respectively (P=0.441). Therefore, the results of the present study indicate that hybrid surgery is a feasible option for the treatment of multilevel peripheral arterial occlusive disease, showing favorable patency and limb salvage rates. These observations indicate that femoral endarterectomy plays a vital role in hybrid surgery.
Collapse
Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 134-727, Republic of Korea
| | - Sun-Hyung Joo
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 134-727, Republic of Korea
| | - Ho-Chul Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 134-727, Republic of Korea
| |
Collapse
|
23
|
Nakayama M, Sakamoto F. Proximal direct endarterectomy combined with simultaneous distal endovascular therapy for chronic full-length occlusion of the superficial femoral artery in elderly patients. Asian J Surg 2013; 36:104-10. [PMID: 23810159 DOI: 10.1016/j.asjsur.2012.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 10/31/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE The most proximal ostial site of the chronic occlusive superficial femoral artery is not suitable for ballooning or stenting because the deep femoral artery may be occluded by these procedures. Thus, the feasibility of performing an open endarterectomy for the occluded ostium of the superficial femoral arteries combined with an endovascular therapy for the remaining distal site was evaluated. METHODS Eleven critically ischemic limbs in 10 elderly patients with poor general health were enrolled. They had full-length occlusion of the superficial femoral artery involving its ostium. The ostial site was managed with an open endarterectomy followed by endovascular therapy for the remaining distal site. RESULTS All procedures were successfully performed. All patients experienced pain relief, and the wounds healed. During the follow-up observation period (average: 23.9 ± 14.7 months), nine patients died. None of the patients, including those who had lost patency of the superficial femoral artery, received major amputation. CONCLUSION Elderly patients, including those who were in terminal stage, were able to withstand the operation, and their postoperative quality of life was not compromised. Although the patency following the surgery was limited, sparing the deep femoral artery could either prevent or delay the recurrence of critical limb ischemia.
Collapse
Affiliation(s)
- Mitsuyuki Nakayama
- Department of Vascular Surgery, Kanoiwa Hospital, Kamikanogawa, Yamanashi City, Japan.
| | | |
Collapse
|
24
|
Lee SS, Jung HJ. Hybrid Operation (Balloon, Stent Covered Stent and/with Bypass, Excise It!): When and How? Vasc Specialist Int 2013. [DOI: 10.5758/kjves.2013.29.2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sang Su Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyuk Jae Jung
- Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
25
|
Yurekli I, Gokalp O, Gunes T, Yilik L, Gurbuz A. Simultaneous hybrid peripheral re-vascularization: early results. Vascular 2013; 21:279-85. [PMID: 23518846 DOI: 10.1177/1708538113478739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2012] [Indexed: 11/16/2022]
Abstract
Endovascular and open surgical interventions may be combined in treatment of peripheral arterial disease. In this study, we presented our simultaneous hybrid peripheral interventions under the light of current literature data. Eleven patients who were operated for occlusive peripheral arterial disease without aneurysms between June 2008 and November 2010 at our hybrid operating room were investigated retrospectively. Generally, endovascular intervention was performed initially, and then followed by surgery. After hybrid interventions, control angiograms were held during the same session. None of the patients experienced either stent or graft occlusion during early postoperative period. Primary patency rate was found to be 100% for the postoperative first six months. Ankle-brachial indices (ABI) increased significantly during postoperative period and clinical symptoms were relieved in all patients (mean preoperative ABI: 0.43 ± 0.08, mean postoperative sixth month ABI: 0.87 ± 0.08). Peripheral hybrid interventions may be performed both in separate sessions and also simultaneously by experienced teams if an angiography device is available within the operating room.
Collapse
Affiliation(s)
- Ismail Yurekli
- Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery
| | - Orhan Gokalp
- Department of Cardiovascular Surgery, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Tevfik Gunes
- Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery
| | - Levent Yilik
- Izmir Ataturk Education and Research Hospital, Department of Cardiovascular Surgery
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| |
Collapse
|
26
|
Balaz P, Rokosny S, Bafrnec J, Björck M. The Role of Hybrid Procedures in the Management of Peripheral Vascular Disease. Scand J Surg 2012; 101:232-7. [DOI: 10.1177/145749691210100402] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper provides a summary of up-to-date information and experience with the combined treatment of patients suffering from peripheral arterial disease (PAD) with endovascular and open surgery, performed simultaneously and in a single operating room. Hybrid intervention is reported to have good results in well-indicated groups of patients with acute and chronic limb ischemia, even with older, high-risk patients. The indications for the use of this technique remain unclear with inconsistent opinions among vascular surgeons. The indications for treatment were divided into three main groups: 1) Patients with chronic limb ischemia, 2) acute limb ischemia, and 3) occlusion of a previous vascular reconstruction. The operating techniques for the most commonly used combinations are described. In conclusion, hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. Modern vascular surgeons need to master both open and endovascular techniques, and to combine them in a creative fashion to the benefit of our patients.
Collapse
Affiliation(s)
- P. Balaz
- Vascular and Transplant Surgery Department, IKEM Prague, Czech Republic
| | - S. Rokosny
- Vascular and Transplant Surgery Department, IKEM Prague, Czech Republic
| | - J. Bafrnec
- Vascular and Transplant Surgery Department, IKEM Prague, Czech Republic
| | - M. Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Sweden
| |
Collapse
|
27
|
Affiliation(s)
- David Paul Slovut
- From the Divisions of Cardiology (D.P.S.) and Vascular and Endovascular Surgery (D.P.S., E.C.L.), Montefiore Medical Center, Bronx, NY
| | - Evan C. Lipsitz
- From the Divisions of Cardiology (D.P.S.) and Vascular and Endovascular Surgery (D.P.S., E.C.L.), Montefiore Medical Center, Bronx, NY
| |
Collapse
|
28
|
Feng H, Chen XM, Li CY, Zhu RM, Fang J, Wang TY. Combined common femoral artery endarterectomy with superficial femoral artery stenting plus Shuxuening Injection infusion for chronic lower extremity ischemia: 3-year results. Chin J Integr Med 2012; 18:417-22. [PMID: 22528759 DOI: 10.1007/s11655-012-1113-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of combined common femoral artery (CFA) endarterectomy with superficial femoral artery (SFA) stenting plus Shuxuening Injection infusion in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities. METHODS From March 2006 to March 2011, 104 lower limbs in 96 patients with multilevel peripheral arterial steno-occlusive disease, involving SFA as well as CFA and deep femoral artery (DFA) orifice, were treated by combined surgical with endovascular therapy, such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein. Before the end of the operation, 20 mL of Shuxuening Injection was infused through the catheter located in the treated artery. Technical and hemodynamic success, as well as primary and primary-assisted patency, was determined according to the Society for Vascular Surgery Guidelines. During follow-up, clinical status assessment, ankle-brachial index (ABI) test, and duplex Doppler ultrasound were administered every 6 months, and computed tomography angiography or magnetic resonance angiography was performed at 12, 24, and 36 months after discharge. RESULTS All patients underwent successful combined CFA endarterectomy with SFA stenting treatment. The average ABI after the combination treatment increased from pretreatment of 0.32±0.21 to 0.82±0.24 (P<0.01). No perioperative death and major limb amputations occurred. The mean duration of follow-up for 104 limbs from 96 patients was 1,180 days (range, 196-2,064 days). During follow-up, 5 patients died due to myocardial infarction, cerebral infarction, or pneumonia, and 5 patients were lost to follow-up. There were 21 cases (21.4%) of restenosis, with 15 that occurred in-stent and 6 near the distal end of the stent. A total of 18 (18.3%) reinterventions were performed, including 6 balloon angioplasty, 8 restenting procedures, 2 bypass surgeries, and 2 major limb amputations. The primary patency rates were 92.2%, 76.8%, and 61.3% at 12, 24, and 36 months, respectively, while the primary-assisted patency rates were 94.4%, 83.2%, and 75.6% at 12, 24, and 36 months, respectively. CONCLUSION The combined CFA endarterectomy with SFA stenting plus Shuxuening Injection infusion appears to offer a safe, less invasive, and effective treatment option to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease.
Collapse
Affiliation(s)
- Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing (100050), China
| | | | | | | | | | | |
Collapse
|
29
|
Sin MH, Chang JH. Staged Hybrid Revascularization in Patients with Peripheral Arterial Occlusive Disease. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.1.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Min Ho Sin
- Department of Surgery, Chosun University School of Medicine, Gwangju, Korea
| | - Jeong Hwan Chang
- Department of Surgery, Chosun University School of Medicine, Gwangju, Korea
| |
Collapse
|
30
|
Kwon MS, Kim JH, Byun SS, Choi ST, Kang J. Initial Experience of Hybrid Vascular Operation. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.4.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mi Sun Kwon
- Department of Surgery, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Jung Ho Kim
- Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Sung Su Byun
- Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Sang Tae Choi
- Department of Surgery, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Jinmo Kang
- Department of Surgery, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| |
Collapse
|
31
|
Laird JR. Endovascular treatment of common femoral artery disease viable alternative to surgery or just another short-term fix. J Am Coll Cardiol 2011; 58:799-800. [PMID: 21835314 DOI: 10.1016/j.jacc.2011.01.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/25/2011] [Indexed: 10/17/2022]
|
32
|
Matsagkas M, Kouvelos G, Arnaoutoglou E, Papa N, Labropoulos N, Tassiopoulos A. Hybrid Procedures for Patients With Critical Limb Ischemia and Severe Common Femoral Artery Atherosclerosis. Ann Vasc Surg 2011; 25:1063-9. [DOI: 10.1016/j.avsg.2011.07.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 07/02/2011] [Accepted: 07/13/2011] [Indexed: 11/29/2022]
|
33
|
Hernández-Lahoz Ortiz I, Couto Mallón D, Vázquez Lago J, Cubillas Martín H, Vidal Insua J, García Casas R. Endarterectomía femoral y angioplastia endovascular simultánea. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
34
|
Muhammad K, Helton T, Theodos G, Kapadia S, Tuzcu EM. Hybrid cardiovascular therapy: interventional (and surgical) procedures in high-risk patients. Interv Cardiol 2011. [DOI: 10.2217/ica.11.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
35
|
Wu H, Sun H, Jiang X, Ma W, Wang X, Zhang J, Hu S. Simultaneous Hybrid Revascularization by Peripheral Artery Stenting and Off-Pump Coronary Artery Bypass: The Early Results. Ann Thorac Surg 2011; 91:661-4. [DOI: 10.1016/j.athoracsur.2010.10.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 11/26/2022]
|
36
|
Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg 2010; 51:1425-1435.e1. [DOI: 10.1016/j.jvs.2010.01.092] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 12/29/2009] [Accepted: 01/28/2010] [Indexed: 11/20/2022]
|
37
|
The Role of “Cutting” Balloon Angioplasty for the Treatment of Short Femoral Bifurcation Steno-Obstructive Disease. Cardiovasc Intervent Radiol 2010; 33:921-8. [DOI: 10.1007/s00270-010-9802-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 01/04/2010] [Indexed: 11/27/2022]
|
38
|
Hybrid Endovascular and Open Treatment of Severe Multilevel Lower Extremity Arterial Disease. Eur J Vasc Endovasc Surg 2009; 38:616-22. [DOI: 10.1016/j.ejvs.2009.06.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 06/20/2009] [Indexed: 11/18/2022]
|
39
|
Slovut DP, Sullivan TM. Combined Endovascular and Open Revascularization. Ann Vasc Surg 2009; 23:414-24. [DOI: 10.1016/j.avsg.2008.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 12/05/2008] [Indexed: 11/29/2022]
|
40
|
Comparison of costs of staged versus simultaneous lower extremity arterial hybrid procedures. Am J Surg 2008; 196:634-40. [DOI: 10.1016/j.amjsurg.2008.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 02/03/2023]
|
41
|
Abstract
Abstract Chronic critical limb ischemia (CLI), defined as > 2 weeks of rest pain, ulcers, or tissue loss attributed to arterial occlusive disease, is associated with great loss of both limb and life. Therapeutic goals in treating patients with CLI include reducing cardiovascular risk factors, relieving ischemic pain, healing ulcers, preventing major amputation, improving quality of life and increasing survival. These aims may be achieved through medical therapy, revascularization, or amputation. Medical therapy includes administration of analgesics, local wound care and pressure relief, treatment of infection, and aggressive therapy to modify atherosclerotic risk factors. For patients who are not candidates for revascularization, and who are unwilling or unable to undergo amputation, treatments such as intermittent pneumatic compression or spinal cord stimulation may offer symptom relief and promote wound healing. Revascularization offers the best option for limb salvage. The decision to perform surgery, endovascular therapy, or a combination of the two modalities (‘hybrid’ therapy) must be individualized. Patients who are relatively fit and able to withstand the rigors of an open procedure may benefit from the long-term durability of surgical repair. In contrast, frail patients with a limited life expectancy may experience better outcomes with endovascular reconstruction. Hybrid therapy is an attractive option for patients with limited autologous conduit, as it permits complete revascularization with a less extensive procedure, shorter duration of operation, and decreased risk of peri-operative complications. Amputation should be considered for patients who are non-ambulatory, demented, or unfit to undergo revascularization.
Collapse
Affiliation(s)
| | - Timothy M Sullivan
- Vascular and Endovascular Surgery, Minneapolis Heart Institute, Minneapolis, MN, USA
| |
Collapse
|
42
|
Abstract
In this article, current evidence-based treatment recommendations for acute and chronic lower limb ischemia will be presented considering the varied possibilities of endovascular techniques and open surgical vascular strategies. Beside presentation of the different therapeutic possibilities, advantages of the combination of both techniques will be described. Despite the BASIL trial, there are no prospective randomised controlled trials comparing endovascular and open surgical interventions. Different therapeutic rules along the different vascular segments will be discussed for both acute and chronic peripheral arterial disease. Generally it can be stated that aortoiliac revascularization for chronic obstructions is increasingly being carried out by endovascular means or hybrid procedures using a minimally invasive femoral approach, whereas acute occlusions in this vascular segment are still treated with open surgical techniques (Fogarty balloon thrombectomy). In the infrainguinal region, endovascular therapeutic strategies are gaining favor. However, multilevel occlusions and long-segment obstructions in the femoral and popliteal segment are still treated by bypass procedures. Acute ischemia in the infrainguinal segment is increasingly treated with endovascular methods (local thrombolysis and percutaneous thrombectomy).
Collapse
Affiliation(s)
- M Storck
- Klinik für Gefässchirurgie, Städtisches Klinikum Karlsruhe gGmbH, Moltkestrasse 90, 76133, Karlsruhe, Deutschland.
| | | |
Collapse
|