Initial experience of hybrid procedures performed for acute limb ischemia

Abstract

Background. Thrombectomy (TE) is an effective treatment for acute limb ischemia (ALI). However,residual thrombus and chronic occlusive-stenotic lesions may limit clinical success rate.The “hybrid procedures” allow identification of underlying lesions and its simultaneous endovascular correction Objective of the study. The aim of study was evaluation of first experience and early results of HP performed on emergency basis in patients with ALI Material and Methods. Our initial experience includes 3 patients with ALI grade IIB of lower limbs who underwent urgent staged HP. The indications for HP was suboptimal result of TE. The immediate technical success was defined as patent artery with <30% residual stenosis. Primary patency, limb salvage rate and value of ankle brachial pressure index (ABPI) were defined as clinical outcomes Results. Open surgery consisted of TE from iliac artery in 1 case and from femoral-popliteal segment in 2 cases. In first case angiography revealed the severe stenosis of common iliac artery and in other two cases - chronic occlusions of tibial arteries. Endovascular stage of HP included: transluminal angioplasty and stenting of common iliac artery in one case and angioplasty of tibial arteries in two. Technical success was achieved in all cases. In the postoperative period the median value of ABPI increased with 0,64. At six-months follow-up the primary patency and limb salvage rates were 100%, and survival rate was 66% Conclusion. Initial experience of HP in patients with ALI offered promising results, demonstrating its feasibility, sufficient efficacy and safety, especially in cohort of high-risk patients. HP for ALI should be implemented in routine practice and evaluated in larger clinical studies.

Background. Thrombectomy (TE) is an effective treatment for acute limb ischemia (ALI). However,residual thrombus and chronic occlusive-stenotic lesions may limit clinical success rate.The “hybrid procedures” allow identification of underlying lesions and its simultaneous endovascular correction Objective of the study. The aim of study was evaluation of first experience and early results of HP performed on emergency basis in patients with ALI Material and Methods. Our initial experience includes 3 patients with ALI grade IIB of lower limbs who underwent urgent staged HP. The indications for HP was suboptimal result of TE. The immediate technical success was defined as patent artery with <30% residual stenosis. Primary patency, limb salvage rate and value of ankle brachial pressure index (ABPI) were defined as clinical outcomes Results. Open surgery consisted of TE from iliac artery in 1 case and from femoral-popliteal segment in 2 cases. In first case angiography revealed the severe stenosis of common iliac artery and in other two cases - chronic occlusions of tibial arteries. Endovascular stage of HP included: transluminal angioplasty and stenting of common iliac artery in one case and angioplasty of tibial arteries in two. Technical success was achieved in all cases. In the postoperative period the median value of ABPI increased with 0,64. At six-months follow-up the primary patency and limb salvage rates were 100%, and survival rate was 66% Conclusion. Initial experience of HP in patients with ALI offered promising results, demonstrating its feasibility, sufficient efficacy and safety, especially in cohort of high-risk patients. HP for ALI should be implemented in routine practice and evaluated in larger clinical studies.