Journal: |
The Egyptian Journal of Surgery
Wolters Kluwer - Medknow
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Abstract: |
Objective
Interventions for multilevel critical limb ischemia include endovascular and surgical
bypass revascularization. A hybrid approach combining both techniques is
progressively used worldwide. The present randomized study proposed to
compare the postoperative and clinical outcomes of surgical bypass and hybrid
approach in patients with multilevel critical lower limb ischemia.
Patients and methods
This clinical randomized study was conducted in the period from September 2014
through April 2019. The study included 52 patients with multilevel critical limb
ischemia. Patients were subjected to open surgical bypass (n=29) or hybrid
intervention (n=23). Assessment included clinical examination, ankle-brachial
pressure index measurement, arterial duplex (including ankle peak systolic
velocity), and computed tomography angiography. Postoperatively, patients
were followed at 1, 3, 6, 12 months, and then annually. The primary outcome in
the present study was patency (primary, primary assisted, and secondary). Other
outcome parameters included technical success (residual stenosis <30%),
postoperative complications, ICU admission, hospital stay, major amputation,
and mortality.
Results
Technical success was achieved in all the studied patients in both groups. Patients
in surgical bypass group had higher rate of ICU admission and significantly longer
hospital stay. In addition, they experienced significantly higher rate of postoperative
wound infection and seroma formation. However, no significant differences were
found between the studied groups regarding primary patency (62.1 vs. 60.9%,
P=0.93), primary assisted patency (75.9 vs. 69.6%, P=0.61), secondary patency
(86.2 vs. 87.0%, P=0.94), major amputation (13.8 vs. 13.0%, P=0.94), and
mortality (10.3 vs. 4.3%, P=0.42).
Conclusion
Hybrid intervention provides patency and limb salvage rates equivalent to Open
surgery. Moreover, the hybrid approach is associated with lower need of ICU
admission and shorter hospital stay, which can reduce the clinical resource
utilization.
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