The role of hybrid procedures in the management of iliac-femoral arteries occlusive disease

In the area of iliac-femoral occlusive disease hybrid approach, which consists in endovascular approach at aorta iliac district combined with the simply endarterectomy of the femoral bifurcation, have been considered as an alternative, especially in patients classified to be at a high risk for surgery. The aim of this study is the evaluation of the results in patients treated by hybrid or open surgery in order to establish whether hybrid treatment could be considered a valid first choice alternative. METHODS: This is a retrospective study in order to identify patients treated for iliac femoral atheromasic disease between January 2001 and January 2014. Patients that presented lesions such as TASC C or D have been considered for this study. For the analysis patients will be divided in two main groups: Open Group (OG), which received the open surgery, and Hybrid Group (HG), which received the Hybrid intervention. The HG patients will be divided in two further groups (A e B), whether they presented respectively segmental lesions or continuous lesions from iliac artery to the femoral artery across the groin ligament. Patients with segmental lesions (group A) were treated by femoral open endarterectomy and iliac stenting. In the group B the endarterectomy was extended from the common femoral artery to the iliac artery in a retrograde way and then an iliac uncovered stent was deployed in order to fix the point of interruption of the plaque after retrograde endarterectomy and in the same time to treat the stenosis above this point. RESULTS: Over a frame time of 13 years, 178 limbs in 164 patients treated for iliac femoral atheromasic disease were identified. One hundred limbs were treated by open approach and seventy-eight limbs were treated with hybrid approach. The median follow-up was 5 years (range: 1-13 years) in both groups. Primary patency at 1, 2 and 5 years in HG was respectively 97.5% and 96% vs. 98% and 97% in the OG. Limb salvage rate at 1, 2 and 5 year in the HG was respectively 96.1%, 96.1% and 93.5% vs. 99%, 98% and 98% in the OP. CONCLUSIONS: This study shows that hybrid procedures resulted to be a valid first choice alternative, providing good results in terms of patency and limb salvage rate Furthermore, hybrid procedures were characterized by low 30-day mortality rate and acceptable complications rate considering the significant comorbidities in these patients.