Outcome after Hybrid Outflow Interventions for Chronic Limb-threatening Ischemia
J Serna Santos1, M Söderström1, R Helminen1
1Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland.
Insights
Hybrid revascularization combining open surgery and angioplasty effectively treats chronic limb-threatening ischemia (CLTI) with multilevel arterial disease, achieving high limb salvage rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic limb-threatening ischemia (CLTI) often involves multilevel arterial disease requiring complex revascularization.
- Multilevel disease necessitates interventions at various sites within the limb vasculature.
Purpose of the Study:
- To evaluate the outcomes of hybrid interventions combining open surgical revascularization with outflow segment percutaneous transluminal angioplasty (PTA).
- To assess the efficacy of this hybrid approach in patients suffering from CLTI.
Main Methods:
- Retrospective analysis of 80 hybrid outflow-PTA interventions performed between 2003 and 2015 for CLTI.
- Patient data were collected prospectively and analyzed retrospectively with a follow-up ending December 2019.
- Common procedures included femoral endarterectomy and superficial femoral artery PTA.
Main Results:
- High limb salvage rates: 92% at 30 days, 91% at 1 year, and 86% at 5-10 years.
- Survival and amputation-free survival rates were 93% and 86% at 30 days, respectively.
- Wound healing rates reached 87% by 12 months, with 72% freedom from target lesion revascularization at 5 years.
Conclusions:
- Hybrid outflow revascularization is a valuable strategy for managing CLTI patients with multilevel arterial disease.
- This approach offers significant limb salvage and improved patient outcomes.
Background And Aims:
Because chronic limb-threatening ischemia (CLTI) is often associated with multilevel arterial disease, it usually requires revascularization at different sites of the limb vasculature. We aim to assess the outcome of the hybrid interventions including open surgical revascularization together with outflow segment percutaneous transluminal angioplasty (PTA) in patients with chronic limb-threatening ischemia.
Material And Methods:
This study included all hybrid outflow-PTA interventions (n = 80) on patients suffering from CLTI performed in Helsinki University Hospital between 2003 and 2015. Follow-up ended on 31 December 2019. Patient data were prospectively collected into our vascular registry and scrutinized retrospectively. Thirty-one patients (39%) suffered from rest pain (Rutherford category IV) and 49 patients (61%) had ischemic ulcers (Rutherford category V-VI). The most common open surgical procedure was femoral endarterectomy (n = 63, 79%) and the most common endovascular procedure was superficial femoral artery percutaneous transluminal angioplasty (n = 65, 81%). Mean follow-up time was 56 months (range: 4 days-183 months).
Results:
Limb salvage was at 30 days-92%, at 1 year-91%, and at 5 and 10 years-86%. Survival and amputation-free survival were at 30 days-93% and 86%, at 1 year-80% and 76%, at 5 years-51% and 48%, and at 10 years-21% and 21%. Wound healing at 3, 6, and 12 months was 48%, 71%, and 87%. Freedom from target lesion revascularization was at 30 days-97%, at 1 year-88%, at 5 years-72%, and at 10 years-66%.
Conclusion:
Hybrid outflow revascularization is an important tool in the vascular surgeon's armamentarium for treatment of patients with multilevel arterial disease causing chronic limb-threatening ischemia.
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