HYBRID PROCEDURES FOR MULTILEVEL FEMORAL AND POPLITEAL ARTERY OCCLUSIVE DISEASE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEI Zhiqing ¹ , YANG Qipeng ¹ , GONG Jieming ¹ , LIU Changjian ²

1Department of Vascular and Endovascular Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210000, P.R.China;;
2Department of Vascular and Endovascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. Corresponding author: WEI Zhiqing, E-mail: wzqnju@aliyun.com;

Corresponding author：

Keywords：

Hybrid procedures; Multilevel artery occlusive disease; Patency rate

DOI：

10.7507/1002-1892.20130295

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Objective To evaluate the immediate and mid-term effectiveness of hybrid procedures (combined open surgery and endovascular therapy) for multilerel femoral and popliteal artery occlusive disease. Methods Between June 2009 and June 2012, 22 cases of severe femoral and popliteal artery occlusive disease were treated by hybrid surgery. There were 15 men and 7 women with an age range of 52-78 years (mean, 66.2 years) and with a disease duration of 6 months to 5 years (mean, 1.5 years). Of 22 patients, 13 had a history of smoking; 8 were classified as Fontaine III and 14 as Fontaine IV. The complications included diabetes (8 patients), hypertension (16 patients), hyperlipemia (10 patients), coronary heart disease (11 patients), and chronic kidney failure (1 patient). Patency analyses were performed using Kaplan-Meier life tables and log-rank test. Results All patients underwent successfully procedures. The time of operation was 70-160 minutes (mean, 137 minutes). Acute myocardial infarction, hematoma of incision, fracture of stent, and stent thrombosis occurred in 1 case, respectively. At 6 months after surgery, the ankle brachial index (ABI), the transcutaneous oxygen pressure (TcpO2), and the average intermittent claudication distance were significantly increased when compared with preoperative ones [0.79 ± 0.33 vs. 0.32 ± 0.18, (42.7 ± 15.7) kPa vs. (17.6 ± 11.6) kPa, and (420 ± 80) m vs. (160 ± 54) m, P lt; 0.05]. The patients were followed up 6-24 months (mean, 14.5 months). The primary patency rate, primary assisted patency rate, and second patency rate were 77.3% (17/22), 90.9% (20/22), and 95.5% (21/22) respectively, showing no significant difference among them (P gt; 0.05). No significant difference was found in various-stage patency rates between patients at Fontaine III and IV (P gt; 0.05). Conclusion Hybrid procedures provide an effective treatment of multilevel femoral artery and popliteal artery disease while there is good outflow.

Citation： WEI Zhiqing,YANG Qipeng,GONG Jieming,LIU Changjian. HYBRID PROCEDURES FOR MULTILEVEL FEMORAL AND POPLITEAL ARTERY OCCLUSIVE DISEASE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(11): 1359-1362. doi: 10.7507/1002-1892.20130295 Copy

1.	Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg, 2010, 51(1): 230-241.
2.	Davies MG. Critical limb ischemia: introduction. Methodist Debakey Cardiovasc J, 2012, 8(4): 2.
3.	Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007, 45 Suppl S: S5-67.
4.	Han DK, Shah TR, Ellozy SH, et al. The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions. Ann Vasc Surg, 2011, 25(1): 15-24.
5.	Iida O, Nakamura M, Yamauchi Y, et al. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv, 2013, 6(1): 68-76.
6.	León LR Jr, Dieter RS, Gadd CL, et al. Preliminary results of the initial United States experience with the Supera woven nitinol stent in the popliteal artery. J Vasc Surg, 2013, 57(4): 1014-1022.
7.	胡骥琼, 王道明, 司春强, 等. 下肢动脉硬化闭塞症侧支循环流出道的解剖学特点及临床应用初探. 中国修复重建外科杂志, 2008, 22(5): 571-574.
8.	Kang JL, Patel VI, Conrad MF, et al. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy. J Vasc Surg, 2008, 48(4): 872-877.
9.	周敏, 刘长建, 乔彤, 等. 杂交手术治疗TASC D型下肢动脉硬化闭塞症的临床分析. 中华外科杂志, 2010, 48(22): 1735-1738.
10.	Matsagkas M, Kouvelos G, Arnaoutoglou E, et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg, 2011, 25(8): 1163-1169.
11.	NishibeT, Kondo Y, Dardik A, et al. Hybrid surgical and endovacular therapy in mutifocal peripheral TASC D lesions: up to three-year follow-up. J Cardiovasc Surg (Torino), 2009, 50(4): 493-499.
12.	张宪生, 郭宏杰, 王维亮. 个体化血管重建术治疗下肢多平面动脉硬化闭塞症. 中国修复重建外科杂志, 2007, 21(7): 671-674.
13.	Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg, 2008, 22(3): 366-371.
14.	Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg, 2009, 38(5): 616-622.
15.	Naoum JJ, Arbid EJ. Bypass surgery in limb salvage: polytetrafluoroethylene prosthetic bypass. Methodist Debakey Cardiovasc J, 2012, 8(4): 43-46.
16.	Kinlay S. Outcomes for clinical studies assessing drug and revascularization therapies for claudication and critical limbischemia in peripheral artery disease. Circulation, 2013, 127(11): 1241-1250.
17.	Hirsch AT, Duval S. Effective vascular therapeutics for critical limb ischemia: a role for registry-based clinical investigation. Circ Cardiovasc Interv, 2013, 6(1): 8-11.
18.	Conte MS. Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg, 2013, 57(2 Suppl): 8S-13S.

1. Varu VN, Hogg ME, Kibbe MR. Critical limb ischemia. J Vasc Surg, 2010, 51(1): 230-241.
2. Davies MG. Critical limb ischemia: introduction. Methodist Debakey Cardiovasc J, 2012, 8(4): 2.
3. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg, 2007, 45 Suppl S: S5-67.
4. Han DK, Shah TR, Ellozy SH, et al. The success of endovascular therapy for all TransAtlantic Society Consensus graded femoropopliteal lesions. Ann Vasc Surg, 2011, 25(1): 15-24.
5. Iida O, Nakamura M, Yamauchi Y, et al. Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE registry, a prospective, multicenter study in Japan with 12-month follow-up. Circ Cardiovasc Interv, 2013, 6(1): 68-76.
6. León LR Jr, Dieter RS, Gadd CL, et al. Preliminary results of the initial United States experience with the Supera woven nitinol stent in the popliteal artery. J Vasc Surg, 2013, 57(4): 1014-1022.
7. 胡骥琼, 王道明, 司春强, 等. 下肢动脉硬化闭塞症侧支循环流出道的解剖学特点及临床应用初探. 中国修复重建外科杂志, 2008, 22(5): 571-574.
8. Kang JL, Patel VI, Conrad MF, et al. Common femoral artery occlusive disease: contemporary results following surgical endarterectomy. J Vasc Surg, 2008, 48(4): 872-877.
9. 周敏, 刘长建, 乔彤, 等. 杂交手术治疗TASC D型下肢动脉硬化闭塞症的临床分析. 中华外科杂志, 2010, 48(22): 1735-1738.
10. Matsagkas M, Kouvelos G, Arnaoutoglou E, et al. Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis. Ann Vasc Surg, 2011, 25(8): 1163-1169.
11. NishibeT, Kondo Y, Dardik A, et al. Hybrid surgical and endovacular therapy in mutifocal peripheral TASC D lesions: up to three-year follow-up. J Cardiovasc Surg (Torino), 2009, 50(4): 493-499.
12. 张宪生, 郭宏杰, 王维亮. 个体化血管重建术治疗下肢多平面动脉硬化闭塞症. 中国修复重建外科杂志, 2007, 21(7): 671-674.
13. Lantis J, Jensen M, Benvenisty A, et al. Outcomes of combined superficial femoral endovascular revascularization and popliteal to distal bypass for patients with tissue loss. Ann Vasc Surg, 2008, 22(3): 366-371.
14. Antoniou GA, Sfyroeras GS, Karathanos C, et al. Hybrid endovascular and open treatment of severe multilevel lower extremity arterial disease. Eur J Vasc Endovasc Surg, 2009, 38(5): 616-622.
15. Naoum JJ, Arbid EJ. Bypass surgery in limb salvage: polytetrafluoroethylene prosthetic bypass. Methodist Debakey Cardiovasc J, 2012, 8(4): 43-46.
16. Kinlay S. Outcomes for clinical studies assessing drug and revascularization therapies for claudication and critical limbischemia in peripheral artery disease. Circulation, 2013, 127(11): 1241-1250.
17. Hirsch AT, Duval S. Effective vascular therapeutics for critical limb ischemia: a role for registry-based clinical investigation. Circ Cardiovasc Interv, 2013, 6(1): 8-11.
18. Conte MS. Critical appraisal of surgical revascularization for critical limb ischemia. J Vasc Surg, 2013, 57(2 Suppl): 8S-13S.

Chinese Journal of Reparative and Reconstructive Surgery

HYBRID PROCEDURES FOR MULTILEVEL FEMORAL AND POPLITEAL ARTERY OCCLUSIVE DISEASE

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