Hybrid procedures for chronic lower limb ischemia: what determines the outcome?

Background: To report the long term outcome of hybrid (combined open and endovascular) procedures for the management of multisegmental chronic peripheral arterial disease.

Methods: A retrospective analysis from a single center during the period 2009-2013. Patency rates, survival and limb salvage were the primary outcomes. Univariate and multivariate analyses were used to assess the association with various factors.

Results: A total of 132 patients (116 males) with mean age of 69±1.4 years, were treated. The technical and hemodynamic success rates were 94% and 97.7% respectively. The primary and assisted primary patency rates in 36 months were 69.7% and 94.7%, respectively. The Hazard Ratio for primary and assisted primary patency failure was 1.94 (95% CI: 1.07-3.51, P=0.029) and 5.55 (95% CI: 1.15-26.79, P=0.033) times higher in diabetic patients, respectively. Limb salvage rate in 36 months was 87.9%. Rutherford category (P=0.046) and previous ipsilateral reconstruction (P=0.011) were the only factors associated with limb loss.

Conclusions: Hybrid procedures are associated with good long term outcomes in the treatment of multisegmental chronic peripheral arterial disease. Diabetes mellitus remains a determinant of worse outcome, while the severity of the disease and previous ipsilateral revascularization are associated with poorer limb salvage.