Hybrid Treatment for Ischemic Limb Salvage in Patients with Subacute Complex Infrainguinal Arterial Occlusions

Abstract

To evaluate safety and efficacy of a hybrid technique using a Fogarty catheter and an angioplasty balloon to retrieve organized thrombosis then endovascular therapy for underlying chronic lesions in subacute ischemic limbs with complex long infrainguinal arterial occlusions. Retrospective study. Patients presented with Rutherford (4:6) critical limb threatening ischemia (CLTI) and reported acute pain onset or worsening of existing symptoms and presented between 15 days and 3 months duration. Included cases underwent hybrid management for limb salvage performing short time inflation with angioplasty balloon to disrupt fibrosis then passing a Fogarty catheter to retrieve thrombosis and finally treating the underlying arterial lesions. Patient characteristics and comorbidities were reported; degree of disease in the crural vessels was described using the Society of Vascular Surgery modified runoff score. Pedal runoff was assessed according to pedal arch state. Study outcomes included technical success, 1-year patency, limb salvage, and amputation free survival (AFS) rates. Fifty-four patients (mean age 57.2), with a mean symptom duration of 7.3 ± 2.6 weeks, underwent the described hybrid management protocol. Mean runoff score was 7.5 ± 1.3. Distal embolization was reported in 11 (20.4%) cases. Technical success was 90.7%. Primary, assisted primary, and secondary patency rates were 64.8%, 75.9%, and 79.6%, respectively. The 1-year AFS was 77.8%. Limb salvage rate was 88.9%. This study suggests that reported hybrid revascularization modality is considered a safe and effective alternative for treating subacute ischemic limb patients.