A Hybrid Technique to Treat Iliofemoral Lesions Using a Covered Stent Associated with Open Femoral Repair.
Aged
Aged, 80 and over
Amputation, Surgical
Combined Modality Therapy
Endovascular Procedures
/ adverse effects
Female
Femoral Artery
/ diagnostic imaging
Hospital Mortality
Humans
Iliac Artery
/ diagnostic imaging
Intermittent Claudication
/ diagnostic imaging
Limb Salvage
Male
Middle Aged
Peripheral Arterial Disease
/ diagnostic imaging
Postoperative Complications
/ mortality
Prosthesis Design
Retrospective Studies
Stents
Time Factors
Treatment Outcome
Vascular Patency
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
17
06
2019
revised:
28
11
2019
accepted:
01
12
2019
pubmed:
24
12
2019
medline:
29
9
2020
entrez:
24
12
2019
Statut:
ppublish
Résumé
To describe a hybrid approach for complex iliofemoral lesions and report short-term and mid-term results. In this single-center retrospective study, all consecutive patients (n = 32, 36 limbs) who underwent hybrid repair of complex iliofemoral lesions between 2012 and 2017 using a conformable self-expandable covered stent for external iliac artery lesions and open repair of the common femoral artery were included. Lesions were responsible for claudication in 13 (36%) limbs, rest pain in 13 (36%) limbs and tissue loss in 10 (28%) limbs. Over a wire crossing the iliac lesion, the covered stent was deployed, externalized through the femoral arteriotomy, and cut at the iliofemoral junction in such a way that no untreated transition zone remained between the stent and the open reconstruction of the femoral artery. Two elderly patients with critical limb ischemia died during the postoperative course, giving in-hospital mortality of 6.2%. Four (12.5%) presented with moderate to severe complications, including one transtibial amputation in a patient who presented with tissue loss at admission. The median follow-up period was 24.1 months (range: 0.8-64 months). One-year and two-year Kaplan-Meier estimates of overall survival were 91% (95% CI: 97-74) and 76% (95% CI: 89-53). One-year and two-year estimates of freedom from major amputation were 96% (95% CI: 99-76) and 91% (95% CI: 97-66). Estimates of primary patency, assisted primary patency, and secondary patency were: 93.7 (95% CI: 77.1-98.4) at 1 year, and 93.7 (95% CI: 77.1-98.4) at 2 years; 96.7% (95% CI: 78.6-99.6) at 1 year, and 96.7% (95% CI: 78.6-99.6) at 2 years; 96.7% (95% CI: 78.6-99.6) at 1 year and 96.7% (95% CI: 78.6-99.6) at 2 years, respectively. Our hybrid approach for iliofemoral lesions provided acceptable mortality and good mid-term patency rates. Further studies with long-term followup are needed to evaluate the safety and durability of this technique.
Sections du résumé
BACKGROUND
BACKGROUND
To describe a hybrid approach for complex iliofemoral lesions and report short-term and mid-term results.
METHODS
METHODS
In this single-center retrospective study, all consecutive patients (n = 32, 36 limbs) who underwent hybrid repair of complex iliofemoral lesions between 2012 and 2017 using a conformable self-expandable covered stent for external iliac artery lesions and open repair of the common femoral artery were included. Lesions were responsible for claudication in 13 (36%) limbs, rest pain in 13 (36%) limbs and tissue loss in 10 (28%) limbs. Over a wire crossing the iliac lesion, the covered stent was deployed, externalized through the femoral arteriotomy, and cut at the iliofemoral junction in such a way that no untreated transition zone remained between the stent and the open reconstruction of the femoral artery.
RESULTS
RESULTS
Two elderly patients with critical limb ischemia died during the postoperative course, giving in-hospital mortality of 6.2%. Four (12.5%) presented with moderate to severe complications, including one transtibial amputation in a patient who presented with tissue loss at admission. The median follow-up period was 24.1 months (range: 0.8-64 months). One-year and two-year Kaplan-Meier estimates of overall survival were 91% (95% CI: 97-74) and 76% (95% CI: 89-53). One-year and two-year estimates of freedom from major amputation were 96% (95% CI: 99-76) and 91% (95% CI: 97-66). Estimates of primary patency, assisted primary patency, and secondary patency were: 93.7 (95% CI: 77.1-98.4) at 1 year, and 93.7 (95% CI: 77.1-98.4) at 2 years; 96.7% (95% CI: 78.6-99.6) at 1 year, and 96.7% (95% CI: 78.6-99.6) at 2 years; 96.7% (95% CI: 78.6-99.6) at 1 year and 96.7% (95% CI: 78.6-99.6) at 2 years, respectively.
CONCLUSIONS
CONCLUSIONS
Our hybrid approach for iliofemoral lesions provided acceptable mortality and good mid-term patency rates. Further studies with long-term followup are needed to evaluate the safety and durability of this technique.
Identifiants
pubmed: 31866550
pii: S0890-5096(19)31049-0
doi: 10.1016/j.avsg.2019.12.010
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
601-608Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.