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Hybrid procedures and distal origin grafts.

¹Division of Vascular Surgery, University of Cincinnati, Cincinnati, OH 45267, USA. amy.reed@uc.edu

Seminars in Vascular Surgery

|December 17, 2009

Summary

Hybrid endovascular and open surgical techniques offer significant benefits for diabetic patients with critical limb ischemia and gangrene. Combining bypass surgery with endovascular procedures in a single session improves outcomes for complex infrainguinal arterial disease.

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Area of Science:

Vascular Surgery
Endovascular Interventions
Diabetic Limb Complications

Background:

Infrainguinal arterial occlusive disease is a common cause of critical limb ischemia.
Diabetic patients often present with multilevel disease, posing treatment challenges.
Current treatments frequently involve endovascular techniques, but may not address all disease aspects.

Purpose of the Study:

To evaluate the effectiveness of hybrid (open and endovascular) techniques for infrainguinal arterial occlusive disease in diabetic patients with gangrene.
To assess the feasibility of combining open bypass surgery with endovascular treatment in a single setting.

Main Methods:

Surgical treatment of infrageniculate disease with distal bypass.
Simultaneous endovascular treatment of the ipsilateral superficial femoral artery.

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Assessment of outcomes in patients with multilevel infrainguinal disease.

Main Results:

Hybrid approaches allow for single-setting treatment, avoiding staged procedures.
This combined strategy addresses the multilevel nature of disease common in diabetic patients.
Published results, though limited, suggest significant patient benefit.

Conclusions:

Hybrid open and endovascular techniques are crucial for managing complex infrainguinal arterial disease in diabetic patients with gangrene.
These combined approaches offer considerable patient benefit and are likely to remain important in vascular care.