Hybrid procedures for patients with critical limb ischemia and severe common femoral artery atherosclerosis

Background: To evaluate the immediate and midterm results of hybrid (combined open surgical and endovascular) lower extremity revascularization procedures in patients with critical limb ischemia (CLI). Material and Methods: Thirty-seven consecutive patients (44 limbs) were treated for CLI using hybrid techniques during a single procedure. The CFA was involved in all limbs and was uniformly treated with endarterectomy and patch angioplasty. Hemodynamically significant atherosclerotic lesions proximal to the CFA were present in 13 limbs, distal to the CFA in 23 limbs, and both above and below the CFA in 8 limbs, and all were treated with endovascular techniques. All patients underwent a detailed clinical assessment and color duplex ultrasonography at 1, 6, and 12 months after the procedure and annually thereafter. Results: The technical success rate was 96.6%, and the limb salvage rate was 95.5%. All patients except three remained free of symptoms without the need for any secondary interventions at the time of the last follow-up. Three patients presented with SFA thrombosis during the first 6 months after the procedure, and two of them had to be amputated. The median follow-up period was 17 months (range: 3-32), and the primary and secondary patency rates at 24 months were 93.2% and 95.5%, respectively. Conclusion: Hybrid lower extremity revascularization procedures can be used to treat CLI with low perioperative morbidity and mortality and good immediate and midterm patency and limb salvage, thus providing an attractive alternative to larger open surgical interventions.