Outcomes of Single Stage Hybrid Revascularization for Multilevel Peripheral Arterial Disease

Introduction: Peripheral arterial disease (PAD) has a prevalence of between 3 to 10% of the general population. Due to multilevel disease often seen in peripheral arterial disease (PAD), straightforward management options are challenging. Hybrid procedure, combining endovascular and open surgery, is an ideal strategy for managing this cohort of patients. The aims of this study were to investigate the suitability of hybrid surgery in those with multilevel PAD.

Methods: This is a single center retrospective study, including all patients who underwent a single stage hybrid revascularization for multilevel peripheral arterial disease in St James's Hospital from June 1991 to January 2021. Patients who presented with acute limb ischaemia, vasculitis, trauma or aneurysms were excluded. All data was collected from a prospectively maintained database. Primary outcomes were primary patency rate and secondary patency rate. Secondary outcomes were major amputation rate, 30-day mortality, and complications.

Results: 163 hybrid procedures were completed over this period, on 115 patients. 26% (30) were female with a median age of 71. 23% (39) were smokers. 51% (83) had known cardiovascular disease, 34% (56) had a diagnosis of diabetes and 20% (33) had chronic kidney disease. 29% (47) presented with claudication, 33% (54) with rest pain and 38% (62). The most common open procedure completed was common femoral endarterectomy (76%) and most common endovascular procedure was iliac angioplasty (46%). The primary patency rate at 1 year was 74% (Figure 1) and secondary patency rate was 85% (Figure 2). Preoperative median ABI was 0.48 (IQR 0.31-0.63), which significantly increased to 0.72 (IQR 0.54-0.99, p <0.005) following intervention. There was a limb salvage rate of 95%, with 5% (9) of limbs required major amputation post operatively. 30 day mortality was 4% (5). 10% (13) had postoperative hemorrhage, with 4.7% (6) requiring intervention. 2.6% (3) experienced respiratory complications and 2.5% (3) experienced cardiac complications.

Conclusion: Within this cohort, there was a primary patency rate of 74% at one year post hybrid procedure and 85% secondary patency rate. There was also a significant improvement in ABI post operatively. This demonstrates hybrid procedures offer an attractive alternative to open or endovascular surgery in those with multilevel disease. Further research is required to quantify long term outcomes within this cohort.

Fig. 1 Primary Patency Rate at 1 year post-operatively

Fig. 2 Secondary Patency Rate at 1 year post-operatively

Publication History

Article published online:
10 June 2022