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Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia
- Source :
- Vascular. 30:891-901
- Publication Year :
- 2021
- Publisher :
- SAGE Publications, 2021.
-
Abstract
- Objective The aim of the study was to evaluate the outcome of first line hybrid treatment in patients with chronic limb threatening ischemia (CLTI) and to evaluate possible predictors of primary patency (PP) loss and limb clinical improvement (LCI). Methods This was a retrospective non-randomized study. All patients underwent one-stage hybrid common femoral artery (CFA) endarterectomy combined with an inflow and/or outflow endovascular revascularization procedure. Demographic, clinical, and lesion characteristics for each patient were reported. Primary patency analysis was performed using Kaplan–Meier life tables, and univariate and multivariate analysis was used to assess possible predictors of PP loss and clinical improvement. Results Complete data were obtained from 132 patients. Patients were divided into two groups according to their Rutherford’s category (RC), group 1 (Rutherford 4) and group 2 (Rutherford 5 and 6). Technical success was 98%. The overall surgical peri-operative complication rate was 8%. At a mean follow-up of 32 ± 23 months, the rate of major adverse limb events (MALE) was 30%; only the rate of major amputation between two groups was significant statistically different ( p = .006). Group 1 had significantly lower amputation rate at 36 months ( p = .01). The presence of high iliac peripheral artery calcium scoring system (PACCS) grade (HR 9.43, 95% CI 2.40–36.9, p = .001), the poor run-off of leg vessels (HR 0.15, 95% CI 0.02–0.92, p = .04), and undergoing CFA endarterectomy combined with outflow endovascular revascularization procedure (HR 4.25, 95% CI 1.07–16.89, p = .04) were independent predictors of PP loss, while severe iliac artery stenosis (OR 0.09, 95% CI 0.02–0.32, p = Conclusion The use of hybrid first line approach in patients with CLTI is a safe and feasible technique. From the analysis of the current study, it is clear that any effort should be made to achieve as many patency leg vessels as possible in order to obtain better and longer lasting clinical outcomes.
- Subjects :
- Chronic Limb-Threatening Ischemia
medicine.medical_specialty
business.industry
First line
Endovascular Procedures
Ischemia
General Medicine
Limb Salvage
medicine.disease
Surgery
First line treatment
Peripheral Arterial Disease
Treatment Outcome
Risk Factors
medicine
Humans
Calcium
Radiology, Nuclear Medicine and imaging
In patient
Cardiology and Cardiovascular Medicine
business
Vascular Patency
Retrospective Studies
Subjects
Details
- ISSN :
- 1708539X and 17085381
- Volume :
- 30
- Database :
- OpenAIRE
- Journal :
- Vascular
- Accession number :
- edsair.doi.dedup.....c0a27bf152d462c55f9515ce2fbcd0de