December 12, 2008

Role of Simple and Complex Hybrid Revascularization Procedures for Symptomatic Lower Extremity Occlusive Disease

Hasan H. Dosluoglu, MD¹, Purandath Lall, MBBS¹, Gregory S. Cherr, MD², Linda M. Harris, MD², Maciej L. Dryjski, MD².
¹VA Western NY Healthcare System, SUNY at Buffalo, Buffalo, NY, USA, ²SUNY at Buffalo, Buffalo, NY, USA.

Objective: The goal of this study is to define the role of simple and complex hybrid techniques in patients who need multilevel revascularization.
Methods: All patients undergoing arterial revascularization(endovascular(EV), open, hybrid) between 06/2001-05/2008 were included. Hybrid procedures were stratified as simple(sHYBRID) when endovascular-treated segment was TASC A/B, complex(cHYBRID), when TASC C/D.
Results: Of the 654 patients, 754 limbs(67% CLI), 227(28%) had open,436(58%) had endovascular, 107(14%) had hybrid procedures(49 sHYBRID,58 cHYBRID). HYBRID group was more likely to have hypertension, COPD, ASA3/4, and aortoiliac reconstructions, with more ASA 4 in cHYBRID than sHYBRID group(Table). HYBRID LOS was significantly longer than EV, but less than open-treated groups. Endovascular intervention was performed for inflow in 93% of hybrid cases; remaining had both inflow and runoff. Eleven(22%) sHYBRID cases were staged, all cHYBRID cases were performed simultaneously. Femoral endarterectomy was more frequent in cHYBRID(76%vs.18% in sHYBRID), infrainguinal bypass(12%vs.57%) was more common in sHYBRID, the remainder being femorofemoral bypasses(12%vs.24%). Most endovascular procedures were iliac PTA/S(96% in sHYBRID,86% in cHYBRID), the remaining was SFA. Thrirty-day MI/death rate was significantly higher in HYBRID than open and EV groups, with no difference within HYBRID group. Patency and limb salvage(LS) rates were better in EV and HYBRID groups. LS rate was better in cHYBRID than sHYBRID group. Overall survival was identical in all groups.
Conclusions: Complex and simple hybrid procedures enable multilevel revascularizations in high risk patients with favorable patency and limb salvage. Femoral endarterectomy plays a central role especially in complex hybrid repairs. A slight increase in perioperative morbidity and mortality was observed in the hybrid group with similar overall survival. This was likely due to attempting revascularization in higher risk patients.

Patient characteristics, perioperative and postoperative results
	Open (n=227)	Endovascular (n=436)	HYBRID (n=107)	P value	Simple HYBRID (n=49)	Complex HYBRID (n=58)	P value
Age	67.8±10.4	69.5±10.6*	66.2±10.0	*<0.05	65.8±10.6	66.7±9.8	0.449
Hypertension/COPD	73%/26%	73%/22%	86%/33%	0.025/0.016	82%/24%	90%/41%	0.272/0.1
ASA 2/3/4	7%/80%/13%	7%/75%/18%	2%/76%/22%	0.023	4%/82%/14%	0/71%/29%	0.029
Aortoiliac/femoropop/infrapop	15%/40%/45%	32%/46%/22%	46%/38%/16%	0.001	39%/41%/20%	53%/34%/12%	0.105
30 day nonfatal MI/mortality	1.3/3.1%	0.9%/1.1%	2.8%/4.7%*	*0.03 vs. EV	4.0%/4.0%	2.0%/5.1%	1.0
36-month PP	57±4%	69±3%	73±6%	0.002	70±9%	76±8%	0.842
36-month SP	71±4%	88±2%	79±5%	<0.001	70±9%	87±6%	0.064
36-month LS	79±3%	87±2%	89±4%	0.012	81±7%	96±4%	0.031
36-month Survival	62±4%	63±3%	60±6%	0.595	64±8%	56±8%	0.656

Back to Annual Meeting
Back to Program