Hybrid Revascularization for Aorto-Iliac Occlusive Disease with Common Femoral Artery Involvement: Early Outcomes of
Oleksiy Gudz1, Ivan Gudz2, Volodymyr Gintchitsky3
1M.D., PhD., Associate professor department of Post-Diploma Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
Insights
Hybrid revascularization combining iliac stenting and femoral endarterectomy offers a safe and effective treatment for aorto-iliac occlusive disease. This approach shows promising early outcomes and is a viable alternative for high-risk patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Aorto-iliac occlusive disease with common femoral artery involvement presents complex challenges for revascularization.
- Traditional open surgical methods may carry significant risks, particularly for high-risk patient populations.
Purpose of the Study:
- To evaluate the early outcomes of hybrid revascularization (HR) for aorto-iliac occlusive disease involving the common femoral artery.
- To report initial single-center experiences and discuss challenges encountered with this hybrid approach.
Main Methods:
- A prospective study of 98 critical limb ischemia patients with TASC-II C and D aorto-iliac lesions treated with HR between January 2017 and September 2020.
- Data collection included demographics, technical success, 30-day and early patency, re-intervention rates, and mortality.
Main Results:
- Technical success was achieved in 98% of patients, with a 100% 30-day patency rate.
- The overall complication rate was 16.3%, with 19.3% requiring delayed bypass procedures for distal occlusions.
- Median follow-up of 18 months showed a primary patency rate of 87.2% and cumulative secondary patency of 93.4%.
Conclusions:
- Hybrid revascularization is a safe and less traumatic option for managing complex aorto-iliac occlusive disease.
- The favorable early patency and low complication rates suggest HR is an excellent alternative to open surgery for high-risk individuals.
Objective:
To study the early outcomes of aorto-iliac occlusive disease with common femoral artery involvement by hybrid methods of revascularization - iliac stenting with femoral endarterectomy. We report the initial experiences of a single centre and discuss issues that arose.
Methods:
Ninety-eight critical limb ischaemia (CLI) patients with aorto-iliac occlusive lesions TASC-II C and D were treated using HR between January 2017 and September 2020 in the Ivano-Frankivsk Regional Clinical Hospital. Prospective data were recorded and analysed including demographics, technical success, 30-day and early patency outcomes, re-intervention, and death.
Results:
The mean age of patients was 65 ± 7.2 years (61 men and 37 women). Using classification by TASC-II, 77% of the lesions were class D. Technical success was seen in 98% of patients. Two patients underwent a crossover femoro-femoral bypass due to failure to re-enter the true lumen of the aorta during endovascular lesion crossing. There were no deaths during the 30-day period. No re-interventions for thrombosis were needed. Additional delayed bypass procedures were required in 19 patients (19.3%) with distal occlusions and minor and major tissue loss. The overall complication rate was 16.3% (16 patients). The 30-day patency rate was 100%. The median follow-up period was 18 months (range 1-36 months) with a primary patency rate of 87.2%, and cumulative primary assisted and secondary patency rate of 93.4%. Four patients died during the study period.
Conclusions:
Hybrid revascularization is a safe and less traumatic method of managing aorto-iliac occlusive disease with common femoral artery involvement. Good early patency results and low major complication rates indicate that HR is an excellent alternative to traditional open surgery, especially for high-risk patients.
