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Complete Lower Extremity Revascularization via a Hybrid Procedure for Patients with Critical Limb Ischemia

Toshio Takayama1, Jon S Matsumura1

  • 11 Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Vascular and Endovascular Surgery
|March 1, 2018
PubMed

Insights

Complete revascularization using hybrid procedures significantly improved limb salvage for critical limb ischemia (CLI) patients. This approach reduced major amputation rates and enhanced amputation-free survival, demonstrating its benefit in treating CLI.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapy

Background:

  • Complete revascularization (CR) is crucial for treating critical limb ischemia (CLI).
  • Hybrid procedures, combining endarterectomy and endovascular treatment, are common for complex lower extremity lesions.
  • This study evaluates the efficacy of CR via hybrid procedures for limb salvage in CLI patients.

Purpose of the Study:

  • To investigate the effectiveness of complete revascularization achieved by hybrid procedures in limb salvage for patients with critical limb ischemia (CLI).

Main Methods:

  • A retrospective analysis of 61 CLI patients (95 limbs) treated with lower extremity hybrid procedures between 2010 and 2016.
  • Patients were categorized into complete revascularization (CR, n=37) and incomplete revascularization (IR, n=24) groups.
  • Key outcomes analyzed included postoperative ankle-brachial index (ABI), patency rates, and major amputation rates.

Main Results:

  • The CR group showed significantly higher postoperative ABIs (0.87 vs. 0.53) and a trend towards lower major amputation rates (2.7% vs. 13%).
  • Major amputation-free survival at 3 years was higher in the CR group (97% vs. 81%).
  • Despite higher initial limb ischemia severity (Rutherford 5) in the CR group, outcomes were favorable.

Conclusions:

  • Complete lower extremity revascularization achieved through hybrid procedures is beneficial for critical limb ischemia (CLI) patients.
  • This approach effectively reduces major amputation rates and improves limb salvage.
  • Hybrid procedures offer a viable strategy for achieving CR and improving outcomes in CLI.
Abstract

Keywords:
critical limb ischemiaendovascular treatmentfemoral accessfemoral arteryfemoral endarterectomyhybrid repair

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