Management of lower limb ischaemia using hybrid techniques: a single-centre experience

Abstract

Introduction: Modern vascular surgery combines procedures with both open and endovascular techniques, with these hybrid procedures becoming part of routine arterial surgery. Hybrid procedures have been established in this centre with access to a hybrid suite since 2014. The aim of this study was to characterise patients undergoing hybrid procedures including an open groin dissection plus an endovascular component. Methods: A retrospective review of operation notes, electronic health records and radiology software for patients undergoing hybrid revascularisation for critical limb threatening ischaemia (CLTI) or intermittent claudication (IC) between January 2017 and December 2021 was performed. Any open groin surgical procedure including common femoral endarterectomy and/or lower limb bypass plus any endovascular procedure were recorded. Primary outcomes were recorded as stent patency, a composite of tissue healing or symptom resolution, and wound complications including surgical site infections. Secondary outcomes were length of stay, rate of readmission and mortality at 30 days. Results: A total of 98 patients (77 men) of median age 73 years (IQR 68–78) underwent a hybrid procedure during this period. Treatment was for CLTI in 66% of the patients and for IC in 34%. The median length of stay was 5 days. Overall graft and stent patency was 85%. The overall rate of tissue healing and symptom resolution was 92%. The surgical site infection rate was 14% (14/98) and mortality at 30 days was 2%. Conclusion: Hybrid revascularisation is safe and effective in treating CLTI and IC with an acceptable risk of surgical site infections. Our short-term results suggest that hybrid revascularisation should be considered in patients with multilevel disease.