Hybrid Management of Critical Limb Ischemia in Assiut University Hospital

Abstract
Background: The alternative of hybrid revascularization surgery combines the well-established patency benefits of open vascular surgery with the advantages of less-invasive endovascular interventions to provide a durable and safe solution for critical limb ischemia.
Aim of Study: The aim of this study was to evaluate the feasibility and efficacy of hybrid therapy in patients with complex multifocal steno-obstructive vascular disease and report short and midterm outcomes through assessment of patency and salvage rates.
Patients and Methods: This study was conducted prospec-tively on thirty patients who presented to the Department of Vascular Surgery of Assiut University Hospital with critical limb ischemia due to multilevel peripheral arterial disease involving CFA from November 2015 to November 2016. All patients underwent detailed history taking, and data were collected on age, sex and risk factors. Patients were further evaluated using clinical examination, measurement of the Ankle Brachial Index (ABI), duplex ultrasound, and computed tomography angiography if needed.
Results: Our study had male predominance (83.3%) with a mean age of 65 years. The most frequent risk factor was smoking in 18/30 (60%). According to Rutherford classifica-tion, the majority of patients (50%) were treated for digital gangrene, followed by minor tissue loss (33.3%) and rest pain (16.7%). Femoral endarterectomy was done in all cases, combined with both proximal and distal endoluminal proce-dures in 40% of patients, with proximal endoluminal proce-dures only in 26.7% and with distal endoluminal procedures in 26.7%. Technical success was achieved in 95.8% of proce-dures. The primary patency rate at 1st, 6th and 12th months were 96.7%, 90% and 80% respectively. Secondary patency rates at 1st, 6th and 12th months were 100%, 83.3% and 67% respectively while limb-salvage rate at 1st, 6th and 12th months were 100%, 100%, and 93.3% respectively. Diabetes has been found to reduce 1-year patency rate with statistically significant difference.
Conclusion: Hybrid lower extremity revascularization procedures can be used to treat CLI with low perioperative morbidity and mortality and good immediate and midterm patency and limb salvage.