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Hybrid procedures and femoral endarterectomy in diabetic patients

R N Berchiolli1, M Marconi, D M Mocellin

  • 1Vascular Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. michemarconi@gmail.com.

European Review for Medical and Pharmacological Sciences
|February 20, 2019
PubMed

Insights

Hybrid procedures combining common femoral endarterectomy (CFE) and endovascular revascularization are safe and effective for critical limb ischemia (CLI). These hybrid approaches show comparable outcomes in diabetic and non-diabetic patients.

Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Critical Limb Ischemia Management

Background:

  • Critical limb ischemia (CLI) poses a significant challenge, often requiring complex revascularization strategies.
  • Hybrid procedures integrating open and endovascular techniques are increasingly utilized for CLI.
  • Evaluating the safety and effectiveness of these hybrid approaches in diverse patient populations is crucial.

Purpose of the Study:

  • To assess the safety and effectiveness of common femoral endarterectomy (CFE) combined with endovascular revascularization (EV) in patients with CLI.
  • To compare outcomes in diabetic (type 1 and type 2) versus non-diabetic patients undergoing these hybrid procedures.
  • To analyze the impact of proximal and/or distal EV procedures in conjunction with CFE.

Main Methods:

  • A retrospective analysis of patients who underwent one-staged hybrid procedures for CLI between January 2008 and December 2011.
  • Patients were categorized into three groups based on the location of EV relative to CFE: proximal, distal, or both.
  • Follow-up evaluations were conducted at 6 and 36 months, with a mean follow-up of 42 months.

Main Results:

  • Out of 635 patients with CLI, 43 met the inclusion criteria for hybrid procedures; 53.5% had diabetes mellitus (DM).
  • Common femoral endarterectomy (CFE) was universally successful, with a 90.7% success rate for associated endovascular procedures.
  • Survival rates at 36 months were 71.9%, with a cumulative limb salvage of 92.1%. No significant differences were observed between diabetic and non-diabetic patients or among the EV groups.

Conclusions:

  • Hybrid procedures involving CFE and EV revascularization are safe and effective for managing CLI.
  • These hybrid approaches demonstrate comparable outcomes in both diabetic and non-diabetic patients.
  • Consideration of hybrid procedures is warranted when indications for CLI treatment are present.
Abstract

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