Hybrid procedure

Editor's Notes

• #2: Dear colleagues Thank you very much for the opportunity to participate in this conference I present you our experience of Hybrid Procedures In Severe Multi Level Lower Extremity Arterial Disease
• #3: By Haimovici H. Peripheral atherosclerotic arterial disease is commonly associated with a multilevel pattern of occlusive disease, especially in patients with critical limb ischaemia. Optimum results may be achieved with both inflow and outflow arterial reconstruction. Simultaneous hybrid endovascular and open lower extremity arterial reconstructive procedures have the advantages of obviating the need for major surgery and avoiding separate taged interventions and their associated morbidity. The term “hybrid” denotes the use of combined open surgical and endovascular techniques simultaneously. In 1994, Marin et al. first reported the use of homemade stent grafts through an arterial cutdown remote from the site of occlusion for limb-salvage.1 Soon after, open surgical femoral exposure for endovascular repair of abdominal aortic aneurysms became the prototype common hybrid procedure.2
• #4: Complete data were obtained from 38 patients who underwent 40 hybrid procedure of multilevel peripheral arterial disease. The mean age was 66 years (range: 39-82) with a male predominance (21 males, 55%).
• #5: According to the Fontaine grading, 16 patients (43%) were treated for severe intermittent claudication , 16 patients (39%) had persistent rest pain and 5 patients (24%) had minor tissue loss . And 1 patient with acute ischemia. Iliac lesions were defined according to the TASC II Type A 5 patients type B 3 patients type D 12 patients
• #6: The most commonly associated cardiovascular risk factors were hypertension (100%), smoking (59%), dyslipidaemia (73.6%), coronary artery disease (76.3%)? Smoking 68.4 % and diabetes (31%).
• #7: The most common open procedure was endarterectomy of the External iliac artery , SFA remote endarterectomy folowed by PTA of BTK vessels 12 cases, Iliac stenting with SFA endarterectomy in 8 cases Iliac stenting Femoro-popliteal bypass 8.
• #8: All patients underwent a postoperative surveillance programme, which consisted of clinical examination, ABI duplex ultrasonography at 1, 3 and 6 months and at 6-month intervals thereafter. Patients with worsening clinical symptoms, physical examinations and/or non-invasive studies were further assessed with digital subtraction angiography or computer-assisted arteriography. The decision on the type of re-intervention was made by the treating surgeon.
• #9: Technical success was achieved in all patients (100%). Mean The mean ABPI increase was 0.40. Mean length of hospital stay (6.1 days) The median follow-up period was 10.5 months (range, 1-18 months); Primary patency rates at 12 months 86.7% Limb salvage rates 95%
• #10: I would like to present you one case. Patients 78 y.o. Occlusion External Iliac artery, common femoral artery and SFA . Critical limb Ischemia(tissue lose). ABI 0.2
• #11: We performed Remote Iliac Endarterectomy Stent Iliac Artery,
• #12: Remote Iliac Endarterectomy Stent Iliac Artery, Remote SFA Endarterectomy SFA
• #13: At this slayd you can see final results. ABI is increase to 1.0
• #14: At this slayd foot after 4 moths
• #15: Hybrid procedures provide an effective treatment of multilevel lower extremity atherosclerotic arterial disease. Our data suggest that the immediate results, expressed as technical and haemodynamic success and the mid-term outcomes, represented by the patency and limb-salvage rates, are satisfactory. Hybrid procedures for the treatment of severe lower extremity arterial disease may provide less invasive therapeutic options tailored to the needs of high risk patients.