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 IF4. Surgical or Endovascular Options for Patients with Acute Limb Ischemia? The Hybrid Procedures May Increase Clinical Outcomes

Gianmarco de Donato, Francesco Setacci, Pasqualino Sirignano, Giuseppe Galzerano, Rosaria Massaroni, Alessandro Cappelli, Carlo Setacci
Department of Medicine, Surgery and Neuroscience, Vascular and Endovascular Surgery Unit, Siena, Italy.
 
OBJECTIVES: Surgical arterial thromboembolectomy (TE) is an efficient treatment for acute arterial emboli of lower limbs, especially if a single large artery is involved. Unfortunately, residual thrombus, propagation of thrombi, chronic atherosclerotic disease and vessel injuries secondary to balloon catheter passage may limit the clinical success rate. Intraoperative angiography can identify any arterial imperfection after TE, which may be corrected simultaneously by endovascular techniques (so-called hybrid procedures (HP)). The aim of this study is to compare outcomes of surgical TE vs. HP in patients with acute limb ischemia (ALI).
 
METHODS: From 2006-2012, 322 patients with ALI were admitted in our department. Patients received urgent surgical treatment using only Fogarty's balloon catheter (FTE group=112) or in conjunction with endovascular completion (HP group=210) on the basis of the surgeon's favorite practices and run-off vessel patency.
In-hospital complications, 30-day mortality, primary and secondary patency, reintervention rate and limb salvage at 24 months were compared in the 2 groups.
 
RESULTS: Hybrid procedures (n=210) following surgical TE consisted in angioplasty (PTA) ± stenting in 98 cases, intraluminal thrombo-aspiration + PTA ± stenting in 47, fibrinolysis + PTA ± stenting in 38, fibrinolysis + intraluminal thrombo-aspiration + PTA ± stenting in 27. Mortality rate at 6 months was 7.4% (8% in the FTE group, and 7.1% in the HP group; p=ns). Primary patency and freedom from reintervention rates at 24 months were superior in the HP group compared to the FTE group, respectively 80.5% vs. 62.5% (p<0.02), and 90.5% vs. 64.3% (p<0.02) Estimated limb salvage at 24 months was 86.6 % in the HP group vs. 74.5% in the FTE group (p=0.3).
 
CONCLUSIONS: Hybrid procedures for ALI may constitute the armamentarium of therapeutic strategies which, when applied to specific clinical scenarios, hold the potential to reduce the morbidity and mortality previously associated with acute arterial occlusion.
 
AUTHOR DISCLOSURES: A. Cappelli: Nothing to disclose; G. de Donato: Nothing to disclose; G. Galzerano: Nothing to disclose; R. Massaroni: Nothing to disclose; C. Setacci: Nothing to disclose; F. Setacci: Nothing to disclose; P. Sirignano: Nothing to disclose.
 
Posted April 2013

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