Role of Hybrid Procedures in the Treatment of Iliac Femoral Occlusive Disease

Abstract

Introduction: At aorta-iliac district for occlusive disease the first choice have became endovascular procedures because offer excellent results in terms of patency, low mortality and morbidity rates. Stenosis/occlusion to the femoral artery may reduce the patency and the technical success rate of the endovascular procedures. In these cases a hybrid approach with femoral endarterectomy and iliac stenting may be considered. We evaluated the results in patients treated by hybrid and traditional surgery in order to establish if these procedures could be considered as the first choice. Methods: We performed a retrospective study analyzing a frame time of 13 years in order to identify patients with iliac femoral atheromatous disease (TASC II C/D). Primary end points have been considered the primary patency rate, limb savage and survival rate. Secondary end points such as secondary assisted patency, re-interventions and complications rate. Results: We identified 178 limbs in 168 patients (100 vs. 78 limbs treated respectively with Open and Hybrid approach). In the Hybrid group 86% of the patients were classified as ASA III/IV vs. 31% in Open group. Median age was 68 vs. 75 respectively per open and hybrid group. Indication for hybrid procedures was given in 93 limbs but after an accurate pre-operative study with Angio-CT scan we excluded 15 limbs due heavy calcification in 13 patients classified as ASA III/IV that underwent to extra-anatomic repair. The technical success was 91.7% vs.100% (Open versus Hybrid). Primary patency in Open vs. Hybrid group at 1, 5 years was respectively 98%,99% vs. 7.5%,96.1%, assisted patency at 1, 5 years 99%, 98% vs. 98.7%, 97.5%, limb salvage at 1, 5 years 99%,98% vs. 96%,93.5%. 30 days mortality and at 1, 5 years were 5.6% e 28.4% vs. 1.2% e 25.6% Open vs. Hybrid group. Similar post-operative complications rate (6%) were observed in both groups, but 8.1% of open group needed admission intensive unit care. Conclusion: Hybrid procedures offered good results in terms of patency and limb salvage rate and with a low 30 mortality in patients classified at high risk for surgery. Similar survival rates between the 2 groups despite the high co-morbidities and older age that characterized the Hybrid group. Considering the good results the hybrid procedures could be considered as the first choice, but in some patients the anatomic arterial features remain the main limitation that still need traditional repair.