The hybrid surgery concepts for atherosclerotic lesions of lower limb arteries
DOI:
https://doi.org/10.34687/2219-8202.JAD.2023.03.0005Abstract
Abstract. The study assessed the outcome of hybrid interventions done in patients with long chronic total occlusions (CTO) of the superficial femoral artery (SFA), patent proximal popliteal artery and extensive crural runoff disease. A series of conventional femoral tibial bypasses was used as historic control.
Aim. To improve the results of lower limb revascularization for extended SFA occlusion combined with tibial artery lesions.
Methods. The study included patients with CLTI (CHD 4), with a long (>20 cm) occlusion of the femoral-popliteal segment arteries and a severe lesion of the outflow channels. 1st group of patients (n-40, age 68.9 7.9, of which 75.0% are men) performed hybrid interventions (autologus femoral-popliteal bypass with endovascular reversal correction of the pathway), 2nd (n-35, age 64.17.2 years; 80.0% of men) - autologus femoral-tibial bypass (FTB).
Results. The incidence of angiosomal revascularization in the distal hybrid (DH) and FTB groups was 90.0% and 69.2%, respectively. The groups did not differ in the incidence of perioperative complications and postoperative bed days. After 1 year, the DH and FTB groups did not differ in terms of overall survival (87.1% and 82.5%), limb preservation (73.7% and 74.9%), freedom from repeat revascularizations (96.0% and 82.0%), and the rate of trophic defect healing (88.2% and 80.0%). The primary patency of the shunt after 1 year was 80.8% in the DH group and 53.2% in the FTB group.
Conclusion. The most effective, modern and high to complete rehabilitation is hybrid method of CLTI revascularization. Pathophysiologically high efficiency of the technique is determined by multimodal approach with cumulation of advantages of open and endovascular methods.
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Copyright (c) 2023 A. A. Кучай, А. Н. Липин , П. С. Курьянов, Н. Н. Груздев, К. А. Атмадзас, Н. Р. Карелина , Л. Ю. Артюх
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