Hybrid Peripheric Interventions for Patients with Critical Limb Ischemia

Purpose: High-risk patients with critical limb ischemia (CLI) caused by multilevel arterial obstructive disease have an important clinical condition, and the prevalence is growing rapidly. We present our surgical experience with CLI patients with either TASC D aortoiliac disease or TASD D femoropopliteal disease.

Materials and Methods: In our center, 25 patients were treated with both intervention and surgery as a hybrid approach for the past year. Eighteen patients had femoropopliteal bypass (10 polytetrafluoroethylene grafts and 8 saphenous veins were used as a conduit), 2 patients had femorofemoral bypass, and 5 patients had femoral thromboendarterectomy and patch plasty operations. Percutaneous transluminal angioplasty (PTA) was performed at the aortoiliac level in 23 patients, and 15 iliac stent were applied. Eight PTA procedures were performed at the femoropopliteal level, and three PTA procedures were done at the infragenicular level. The patients had multiple risk factors; 12 of patients had a previous intervention history, and 1 patient had a popliteal artery aneurysm with occlusive disease.

Results: As a result, the patients presented with CLI were treated both surgically and with balloon angioplasty and stenting at multilevel arterial occlusive disease. The postprocedural revascularization success rate was good, and the symptoms were decreased. The pedal pulses were palpable. The ankle–brachial index was increased after the treatment up to normal levels. Ischemic wound healing was observed in a short period of time ranging from 2 to 8 weeks. Meticulous risk factor control and medical therapy were also applied for all patients. The best medical therapy included dual antiplatelet therapy, cilostazol, and antilipid agents.

Conclusions: Hybrid operating techniques are often useful when treating complex problems and multilevel disease in patients with chronic or acute lower limb ischemia. This type of approach may result in excellent early patency and limb salvage rates. The simultaneously performed hybrid peripheric operations for patients with CLI may be the preferred treatment option.