A new endovascular strategy utilizing a hybrid procedure for long segmental occlusion by acute arterial thromboembolism in the lower extremity.

PURPOSE: To evaluate a new endovascular strategy utilizing a hybrid procedure for long segmental arterial thromboembolism in a lower extremity by historical comparison with conventional endovascular strategy.

MATERIALS AND METHODS: In a new endovascular strategy, a hybrid procedure was performed for long segmental thromboembolism (longer than 15 cm) and an endovascular procedure for short segmental thromboembolism. The new strategy group (Group A) consisted of 24 procedures (13 hybrid procedures, 11 endovascular procedures) in 19 patients. Data were retrospectively collected from 24 consecutive procedures in 23 patients treated with the conventional strategy (Group B).

RESULT: The technical success of Groups A and B was 24/24 and 20/24, respectively (p = 0.11). Major amputation or mortality was not observed in Group A, whereas 3 major amputations and 4 deaths occurred in Group B. Clinical failure in Groups A and B was 0/24 and 7/24, respectively (p < 0.05). Continuous urokinase (UK) infusion was needed in 1/24 in Group A and 14/24 in Group B (p < 0.05). Mean procedure time was 4 h 17 min for Group A and 21 h 30 min for Group B (p < 0.05).

CONCLUSION: The hybrid procedure may be faster and more effective than the conventional treatment in long segmental arterial thromboembolisms, while the conventional treatment is still effective for short segmental occlusions.