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2. Long-Term Results of Below-The-Knee Bypass Using a Prosthetic Graft with a Distal Arteriovenous Fistula Interposition

Author

Spinelli, Francesco, primary, Roscitano, Giuseppe, additional, Barillà, David, additional, Derone, Graziana, additional, Nenna, Antonio, additional, Montelione, Nunzio, additional, Catanese, Vincenzo, additional, Cutrupi, Andrea, additional, Giambra, Martina Maria, additional, Varrà, Alessandra, additional, Veroux, Pier Francesco, additional, and Stilo, Francesco, additional

Published
2023
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13. Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease

Author

Guido Bajardi, Umberto Bracale, Felice Pecoraro, Ettore Dinoto, Marco Panagrosso, Andrea Cutrupi, Dinoto, Ettore, Pecoraro, Felice, Cutrupi, Andrea, Bracale, Umberto M., Panagrosso, Marco, Bajardi, Guido, Dinoto E., Pecoraro F., Cutrupi A., Bracale U.M., Panagrosso M., and Bajardi G.

Subjects
medicine.medical_specialty, Arterial disease, medicine.medical_treatment, Disease, Revascularization, Renal artery stenosis, Settore MED/22 - Chirurgia Vascolare, 03 medical and health sciences, 0302 clinical medicine, Intensive care, medicine.artery, Case report, Peripheral arterial disease, medicine, Renal artery, Endovascular, business.industry, Blood flow, Hybrid approach, medicine.disease, Surgery, Hybrid procedure, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business
Abstract

Highlights • Multilevel peripheral arterial disease in diabetic patients is cause of amputation. • Herein we report a case of critic limb ischemia addressed by hybrid procedure. • Hybrid procedure outcomes seem to be as good as with open revascularization. • Hybrid procedure show less morbidity and shorter intensive care and hospital stay., Introduction Multilevel peripheral arterial disease (MPAD) is the main cause of critic limb ischemia (CLI). Vascular interventions are required to increase distal blood flow and reduce the risk of lower limb amputation. Presentation of case We report a case of complex hybrid revascularization in a patient presenting a Rutherford V MPAD involving the infrarenal aorta, iliac, femoral and popliteal segments. The simultaneous hybrid intervention consisted of an endovascular aortic stent-graft placement and a surgical above-the-knee prosthetic femoro-popliteal bypass. In the same operation a renal stenting was performed due to a significant renal artery stenosis associated to a systemic hypertension non-responder to medical management. Discussion Hybrid interventions can be performed simultaneously or staged with benefit given by the complementary role of endovascular and surgical treatments allowing the correction of eventually inadequate results of both approaches. Reports of simultaneous hybrid treatments are limited but, despite the complexity of such procedures, primary success rate is reported high. Also in the reported case, a complex simultaneous treatment in a patient presenting MPAD in association to a significant and symptomatic renal artery disease was feasible in the same operation. Conclusion Hybrid procedure are safe with high degree of efficacy in terms of revascularization procedure, reduced morbidity and shorter intensive care and hospital stay. In our experience, the use of hybrid procedure is technically feasible and allowed the treatment of MPAD with a good outcomes.

Published
2020

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