Role of Hybrid Interventions in Management of Critical Lower Limb Ischemia

Aims: To evaluate safety and efficacy of the hybrid technique in revascularization of multilevel lower limb arterial occlusive disease in patients with critical lower limb ischemia.

Study Design: A prospective non comparative interventional study.

Place and Duration of Study: It was conducted between February 2017 and June 2019 in the Department of Vascular Surgery, Tanta University hospital.

Methodology: The study included 23 patients were treated with hybrid intervention techniques, and data were collected prospectively. Detailed history was taken and clinical examination was done for every patient along with routine laboratory investigations and radiological work up like duplex scanning with or without CT angiography. All patients were undergone hybrid interventions in an operating room with imaging facilities (mobile c-arm device) where both surgical and endovascular interventions were done simultaneously.

Results: Twenty three patients were treated for unilateral critical lower limb ischemia using single session elective hybrid intervention. The patients age ranged from 46 to 76 (mean 62.6) with 19 males. 8 patients (34.8%) presented with ischemic rest pain and the remainder (65.2%) presented with tissue loss (ischemic ulcer or gangrene). most common inflow procedure was femoro-popliteal supragenicular bypass, and the commonest outflow procedure was tibial angioplasty. Technical success was achieved in 22 patients. Mean ABI was improved from 0.49 preoperatively to 0.84 in early post-operative measurements. Out of 23 limbs treated there were 20 limbs saved from amputation (87% limb salvage rate). We had three mortalities from other co-morbidities and four minor complications treated conservatively and resolved.

Conclusion: Hybrid interventions were proved to be reasonable, effective and safe option for treatment of critical lower limb ischemia.