Hybrid and open surgery of Trans-Atlantic Inter-Society II type C and D iliac occlusive disease and concomitant lesion of common femoral artery.

BACKGROUND: The purpose of our study was to compare immediate and long-term results of hybrid repair and open aortofemoral reconstructions in the patients with lower extremity peripheral arterial disease of Trans-Atlantic Inter-Society (TASC) II Type C and Type D iliac lesions in combination with the concomitant lesion of common femoral artery (CFA).

METHODS: We have included in this prospective case-controlled study 112 patients with extensive iliac and CFA occlusive disease. The study was conducted from 2009 till 2014. In the first group there were 46 patients who received recanalization and stenting of iliac arteries in combination with endarterectomy and angioplasty of common femoral and deep femoral arteries. In the second group there were 66 patients who received aortofemoral bypass. All patients had chronic ischemia (Stage 3-5, Rutherford classification) for TransAtlantic Inter-Society (TASC II) type C and D iliac occlusive disease.

RESULTS: We have not found any significant differences in demographic details between the groups. At the same time there were significant differences in clinical data (coronary heart disease and stage of chronic ischemia) between the groups. Early (<30 days) thrombosis of the stented iliac segment or aorto-femoral bypass was detected in three patients (6.5%) in the first group and three cases (4.5%) in the second group. Thrombectomies using a Fogarty catheter were successful performed in both groups. The average length of the follow-up was 3.1 years (in the range of 6 to 48 months), with a mean follow-up of 3.3 years for the open repair (range 6-48 months) and 2.8 years for the hybrid repair (range 6-48 months) group. At the end of the follow-up period, thrombosis of the stented iliac segment or aortofemoral bypass was detected in 5 (10.9%) patients of the 1st group and 5 (7.8%) patients of the 2nd group. The cumulative primary patency rates at 12, 24 and 36 months were 95.7%, 90.8%, 84.3% in the 1st group and 98.5%, 95.4%, 90.4% in the 2nd group, respectively (P=0.84). The limb salvage rates in our study at 12 and 24 months were 97.8% and 93.8% in the 1st group and 100% and 98% in the 2nd group, respectively (P=0.23).

CONCLUSIONS: Hybrid surgery including recanalization and stenting of iliac artery in combination with endarterectomy and angioplasty of common femoral and deep femoral arteries is an effective (at least in the mid-term period) minimally invasive treatment for patients with multifocal peripheral artery disease. This single-center study supports the safety and durable efficacy of hybrid procedures in a limited cohort of patients, thus emphasizing the need for larger scale clinical trials to evaluate this approach against aortofemoral bypass.