Advantages of the hybrid revascularization technique in the treatment of extended occlusions of the superficial femoral artery and multilevel lesions of the lower extremity arteries

Abstract

Introduction. Atherosclerotic lesions of the lower extremity arteries often have a multilevel character, the consequence of which is the disability of the population up to the development of post-ischemic necrosis. Conventional methods of surgical treatment of occlusion of the superficial femoral artery (SFA) and multilevel arterial lesions, however, are characterized by high traumatism causing an increase in mortality in this cohort of patients. Overcoming the above disadvantages required the development of alternative approaches, particularly hybrid revascularization. Objective. To analyze our own experience of the above-mentioned intervention in order to further evaluate its benefits. Material and methods. The study included 80 patients suffering from chronic limb-threatening ischemia (CLTI) with occlusion of the femoral-popliteal segment arteries >20 cm long. The subjects were divided into two equal groups depending on the type of surgery performed – autovenous femoral-popliteal bypass with endovascular correction of outflow channels (hybrid bypass) or autologous femoral-tibial bypass (FTB). We analyzed the clinical and demographic characteristics of the patients, technical features of interventions, as well as their direct and long-term effects. The assessment of the shunt patency was carried out using Kaplan-Meyer tables. The differences in indicators between groups were determined using the logarithmic criterion. Results. Thirty-day mortality among patients in the hybrid bypass group was 2.5% versus 4.3% in the second group (p>0.05). The frequency of graft failure is 5% versus 13%, respectively. A year after the operation, the primary shunt patency reached 77.7% (95% CI 61.7-93.7) in the first group. In the second group, this indicator was 57.1% (95% CI 42.9-71.3). One-year survival without amputation was 82.1% (95% CI 66.8-97.4) versus 69.6% (95% CI 56.1-83.1), respectively. The frequency of angiosomal revascularization in patients who underwent hybrid bypass surgery reached 90.0%. In the other group, the indicator was lower and amounted to 69.2% (p=0.006). Conclusions. The presented information proves the high efficiency of the investigated method of treatment.