Outcomes of hybrid operations in multi storeyed lesions of arteries of the aortoiliac and femoropopliteal segments

Troitsky A.V., Bekhtev A.G., Khabizov R.I., Belyakov G.A., Lysenko E.R., Skrubert V.S., Gryaznov O.G., Azaryan A.S., Solovieva E.D., Zakharovа I.M.

Centre of Cardiovascular and Endovascular Surgery of Public Health Care Clinical Hospital № 119 under the Federal Biomedical Agency of Russia, city of Khimki, Moscow Region, Russia

The work was aimed at analysing immediate and remote outcomes of hybrid operations in storey atherosclerotic lesions of the aortoiliac and femoropopliteal segments. Over the period from 1997 to 2012 hybrid operations were performed in a total of 224 patients presenting with multi-storeyed lesions of iliac and lower-limb arteries, classified as TASC A, B, C, and D. The operations were carried out at departments of vascular surgery of Clinical Hospital No 83 of the Federal Biomedical Agency of Russia and the Centre of Cardiovascular and Endovascular Surgery of Clinical Hospital No 119 of the Federal Biomedical Agency of Russia. All operations were simultaneous. The patients were subdivided into groups according to the character of intervention on iliac arteries: 1 – balloon angioplasty of iliac arteries, 2 – stenosing of iliac arteries, 3 – loop endarterectomy from iliac arteries followed by implantation of a covered stent into the zone of rupture of the intimal cylinder. In all cases the interventions of the arteries of the aortoiliac segment were combined with various open surgical reconstructions of the femoropopliteal segment. Technical success amounted to 99.1%. Interventional complications of the endovascular stage requiring conversion occurred in 2 cases. The immediate period complications influencing patency of the reconstructions performed were noted in 10 (4.5%) patients. Patency on the hospital stage with the deduction of cases of technical failures amounted to 98.6%. The remote results were followed up during 5 years in 76.5% of patients. Five-year primary assisted patency of the aortoiliac zone amounted to: in group 1 – 79.2%, in group 2 – 77.9%, and in group 3 – 89.4%. Five-year assisted patency of the femoropopliteal segment amounted to: for EAE of the common femoral artery – 98.2%, for profundoplasty – 100%, femoral proximal popliteal bypass grafting – 77.3%, femoral distal popliteal bypass grafting – 74.1%, femoral-tibial bypass grafting – 61.4%. There were no statistically significant differences in patency of the reconstructions of the femoropopliteal segment depending upon the type of intervention on the aortoiliac segment.

KEY WORDS: loop endarterectomy, hybrid operations, stenting of iliac arteries.

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