Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease

Min Zhou, Dian Huang, Chen Liu, Zhao Liu, Min Zhang, Tong Qiao, Chang-Jian Liu Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China Objective: To compare outcomes of hybrid (combined surgical and endovasc...

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Autores principales:	Zhou M, Huang D, Liu C, Liu Z, Zhang M, Qiao T, Liu CJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	hybrid procedure atherosclerotic occlusive disease endovascular treatment Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/dd061d7e3ae54bb6b7f3f35faa6fef59
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spelling	oai:doaj.org-article:dd061d7e3ae54bb6b7f3f35faa6fef592021-12-02T00:19:07ZComparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease1178-1998https://doaj.org/article/dd061d7e3ae54bb6b7f3f35faa6fef592014-09-01T00:00:00Zhttps://www.dovepress.com/comparison-of-hybrid-procedure-and-open-surgical-revascularization-for-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Min Zhou, Dian Huang, Chen Liu, Zhao Liu, Min Zhang, Tong Qiao, Chang-Jian Liu Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China Objective: To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases. Design: Case series study with retrospective analysis of prospectively collected nonrandomized data.Methods: Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan–Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency.Results: HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P<0.001, respectively), and the presence of diabetes and renal insufficiency were another two independent predictors of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively).Conclusion: Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency. Keywords: hybrid procedure, atherosclerotic occlusive disease, endovascular treatment Zhou MHuang DLiu CLiu ZZhang MQiao TLiu CJDove Medical Pressarticlehybrid procedureatherosclerotic occlusive diseaseendovascular treatmentGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1595-1603 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	hybrid procedure atherosclerotic occlusive disease endovascular treatment Geriatrics RC952-954.6
spellingShingle	hybrid procedure atherosclerotic occlusive disease endovascular treatment Geriatrics RC952-954.6 Zhou M Huang D Liu C Liu Z Zhang M Qiao T Liu CJ Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
description	Min Zhou, Dian Huang, Chen Liu, Zhao Liu, Min Zhang, Tong Qiao, Chang-Jian Liu Department of Vascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China Objective: To compare outcomes of hybrid (combined surgical and endovascular) procedures (HYBRID) with open surgical reconstructions (OPEN) in patients with multilevel infrainguinal artery occlusive diseases. Design: Case series study with retrospective analysis of prospectively collected nonrandomized data.Methods: Between 2008 and 2012, 64 patients underwent OPEN and 43 underwent HYBRID. Patient characteristics, technique success, clinical improvement, and procedure-related morbidity were reviewed and compared. Patency rates and limb salvages were analyzed and compared using Kaplan–Meier life tables. Cox regression analyses were used to assess the influence of various risk factors on primary patency.Results: HYBRID patients were older and presented with worse New York Heart Association function compared with OPEN patients. The increase in the ankle-brachial index and improvement of Ruthford category after procedures were equivalent between two groups, but HYBRID patients had shorter hospital length of stay (7.6±12.0 versus 15.5±17.3; P= 0.018) and less overall perioperative morbidity (12% versus 28%; P=0.042) compared with OPEN patients. No statistically significant difference in 36-month primary (47.1%±7.1% versus 50.1%±9.4%; P=0.418), assisted primary (57.0%±7.9% versus 62.4%±9.2%; P=0.517), or secondary (82.0%±6.8% versus 83.1%±7.3%; P=0.445) patency was seen between the two groups. Limb salvage rates of HYBRID vs OPEN at 3 years were similar (76.3%±9.3% versus 80.4%±8.2%; P=0.579). Critical limb ischemia was a negative predictor of long-term patency of patients in both the HYBRID and OPEN groups (P=0.012 and P<0.001, respectively), and the presence of diabetes and renal insufficiency were another two independent predictors of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively).Conclusion: Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency. Keywords: hybrid procedure, atherosclerotic occlusive disease, endovascular treatment
format	article
author	Zhou M Huang D Liu C Liu Z Zhang M Qiao T Liu CJ
author_facet	Zhou M Huang D Liu C Liu Z Zhang M Qiao T Liu CJ
author_sort	Zhou M
title	Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
title_short	Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
title_full	Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
title_fullStr	Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
title_full_unstemmed	Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
title_sort	comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/dd061d7e3ae54bb6b7f3f35faa6fef59
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Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease

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