Hybrid Surgical and Radiological Revascularization for Diabetic and Non-Diabetic Lower Limb Ischaemia

Background: Multi-level occlusive arterial disease involving the iliac and distal arteries can be treated with major bypass, sequential or single stage radiological and surgical procedures. We report our experience with the single stage hybrid approach.  Methods: All patients who underwent hybrid intervention between June 2008 and June 2011 were reported. Patients deemed medically unfit for major bypass or with insufficient veins were mainly considered. Prospective database of patients, procedures and complications with retrospective review of inpatient, outpatient and operative notes, computed tomographic angiography and duplex scan was performed.  Results: Twenty three patients underwent 24 single stage procedures. The patient age ranged from 49 to 88 years (mean 70) with 19 males. Fifteen (65%) patients presented with intermittent claudication, 12 (52%) with short distance ( ≤ 100 yards) claudication, 12 (52%) with tissue loss and 8 (35%) with rest pain. Overall, 18 (78%) patients were presented with critical ischemia limb. The commonest procedures were iliac angioplasties with endarterectomies or bypasses, 23 out of 24 procedures (96%) were technically successful and 20 out of 22 patients (91%) followed up had clinically successful outcome. The mean ankle brachial pressure index improved from 0.57 to 0.71. Two patients (9%) died, 2 patients (9%) developed severe complications and 6 patients (26%) developed moderate complications within 30 days. Conclusion: Single stage hybrid radiological and surgical procedure for lower limb ischemia is feasible providing high technical and clinical success in patients unfit for major bypass or with limited vein conduit. It saves one admission providing patient convenience and potential cost savings. doi: http://dx.doi.org/10.4021/jcs101w