Hybrid surgical treatment of a multilevel lesion of lower-limb arteries

Puzdryak P.D.^1,2, Shlomin V.V.¹, Shloido E.A.¹, Ivanov M.A.², Didenko Yu.P.¹, Kasyanov I.V.¹, Bondarenko P.B.¹, Grebenkina N.Yu.¹, Rakhmatillaev T.B.¹

1) Municipal Multimodality Hospital No 2,
2) Department of General Surgery, North-Western State Medical University named after I.I. Mechnikov under the RF Ministry of Public Health, Saint Petersburg, Russia

The study was aimed at assessing immediate postoperative and remote results of hybrid surgical treatment of patients with a multilevel lesion of lower-limb arteries.

Described herein is the authors’ experience with simultaneous hybrid surgical management of 48 patients, including 43 subjects with a multilevel lesion of arteries of the lower extremities. There were 40 men and 8 women, with the average age amounting to 65.8±7.9 years. Of these, 30 patients suffered from stage II-b chronic arterial insufficiency (CAI), 11 had stage III CAI and 7 had stage IV CAI according to A.V. Pokrovsky classification. While planning the hybrid operation on the arteries of lower limbs we assessed the type of the lesion to the aortofemoral and femoropopliteal segments according to TASC II. All patients were subdivided into 3 groups, depending on the type of hybrid operations: Group I (n=17) – aortofemoral segment, Group II (n=5) – femoropopliteal segment, and Group III (n=26) reconstruction of both above-mentioned segments.

The technical success amounted to 93.7% in revascularization of all types of lesions of the arteries of lower limbs with the use of hybrid vascular reconstructions. The mean duration of the operation was 231.8±90.7 min, including that of the open stage amounting to 126.4±72.8 min and that of the endovascular stage to 105.4±62.9 min. In the immediate postoperative period there were 2 complications requiring repeat reconstructive operation. The ankle-brachial index (ABI) after the intervention increased from 0.43±0.17 to 0.85±0.12. The duration of follow-up averaged 23.4±15.1 months (range 1.9–45.2 mos). Primary patency at 6 months was 94%, at 12 months 94%, at 24 months – 85% and at 36 months – 79% in all groups studied. Four patients during the follow-up period were subjected to amputation. The limb salvage rates were as follows: during 36 months in all patients – 91.6%, in those with stage II-b CAI – 93.3% and in those with critical lower-limb ischaemia – 88.8%. The overall survival rate was 95.8%.

The use of a hybrid method in treatment of a multilevel lesion of lower-limb arteries with revascularization of the aortofemoral and femoropopliteal segments proved efficient both in the immediate and remote periods.

KEY WORDS: hybrid operation, multilevel lesion, atherosclerosis obliterans, peripheral artery disease, endovascular angioplasty.

P. 89

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