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Submitted
25 November 2019
Accepted
18 March 2022
Published
5 December 2022
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Abstract

Highlights:



  1. A patient had a long segment of total occlusion to the proximal right common iliac and anterior tibial artery.

  2. The treatment is a combination of percutaneous transluminal angioplasty (PTA) using vascular stent and the Fogarty thrombectomy.

  3. Hybrid procedure can treat multilevel artery occlusive diseases, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy.


 


Abstract:


Critical limb ischemia is a condition that threatens the viability of lower extremities and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method for critical limb ischemia. Revascularization using a hybrid of endovascular and open surgery is a minimally invasive procedure that performs well as the treatment for medically high-risk patients. A hybrid procedure should be considered for patients with high surgical risk. However, there are factors that could compromise its long-term patency, such as critical limb ischemia and diabetes. This study reported a case of a 53-year-old Asian male with history of insulin-dependent diabetes mellitus and long-standing tobacco use, presented with pain in the right leg at rest approximately 30 days prior  to  admission.  Physical  examination  revealed  a  low  temperature  and  remarkable  non-palpable  pulses  in  the  right  femoral, posterior tibial, and dorsalis pedis segments. Arteriography with run-offs revealed a long segment of total occlusion from the proximal right common iliac and anterior tibial artery. There was non-significant stenosis in the right popliteal artery. The patient was treated using a combination of percutaneous transluminal angioplasty (PTA) of the right common iliac artery using vascular stent and the Fogarty thrombectomy of the common femoral artery, equipped with an X-ray system and a moveable radiolucent surgical table. The anticoagulant  used  on  the  patient  during  the procedure  was  heparin.  There  was  no  residual  stenosis  after  the  procedure  on  the occlusion along the right common iliac artery to the common femoral artery. In conclusion, multilevel artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. 

Keywords

Percutaneous transluminal angioplasty surgery thrombectomy critical limb ischemia hybrid procedure tabacco use

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How to Cite
Oktaviono, Y. H. (2022). Hybrid Procedure in Aortoiliac Bifurcation and Femoral Lesion. Folia Medica Indonesiana, 58(4), 348–354. https://doi.org/10.20473/fmi.v58i4.16270
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References

  1. Abu Dabrh AM, Steffen MW, Undavalli C, et al (2015). The natural history of untreated severe or critical limb ischemia. J Vasc Surg 62, 1642-1651.
  2. Adam D, Beard J, Cleveland T, et al (2005). Bypass versus angioplasty in severe ischaemia of the leg (BASIL): Multicentre, randomised controlled trial. Lancet 366, 1925–34.
  3. Ahmed HM, Nanjundappa A, Laird JR (2005). Complications after iliac artery interventions. Endovasc Today, 55–7.
  4. Aho P-S, Venermo M (2012). Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg 101, 107–13.
  5. Caro J, Migliaccio-Walle K, Ishak KJ, et al (2005). The morbidity and mortality following a diagnosis of peripheral arterial disease: Long-term follow-up of a large database. BMC Cardiovasc Disord 5, 14.
  6. Cotroneo AR, Iezzi R, Marano G, et al (2007). Hybrid therapy in patients with complex peripheral multifocal steno-obstructive vascular disease: two-year results. Cardiovasc Intervent Radiol 30, 355–61.
  7. Fekry A, Regal S, Elwakeel H, et al (2021). Hybrid technique: Common femoral artery endarterectomy and endovascular therapy in critical lower limb ischemia. Mansoura Med J 50, 18–31.
  8. Hardman R, Jazaeri O, Yi J, et al (2014). Overview of classification systems in peripheral artery disease. Semin Intervent Radiol 31, 378–88.
  9. Jung HJ, Lee SC, Kim KY, et al (2018). Simultaneous hybrid operation common femoral endarterectomy and endovascular treatment in multilevel peripheral arterial disease with critical limb ischemia. Indian J Surg 80, 140–5.
  10. Klein AJ, Feldman DN, Aronow HD, et al (2014). SCAI expert consensus statement for aorto-iliac arterial intervention appropriate use. Catheter Cardiovasc Interv 84, 520–8.
  11. Kwa AT, Dawson DL, Laird JR (2011). Covered stents for treating aortoiliac occlusive disease. Endovasc Today53–6.
  12. Murabito JM, Evans JC, Nieto K, et al (2002). Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J 143, 961–5.
  13. Mustapha JA, Diaz-Sandoval LJ, Saab F (2014). Tibioperoneal CTOs in patients with critical limb ischemia. Endovasc Today, 42–54.
  14. Nelson PR, Powell RJ, Schermerhorn ML, et al (2002). Early results of external iliac artery stenting combined with common femoral artery endarterectomy. J Vasc Surg 35, 1107–13.
  15. Norgren L, Hiatt WR, Dormandy JA, et al (2007). Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45, S5–67.
  16. Patel S, Donati T, Zayed H (2014). Hybrid revascularization of complex multilevel disease: a paradigm shift in critical limb ischemia treatment. J Cardiovasc Surg (Torino) 55, 613–23.
  17. Porter J, Eidemiller C, Dotter C, et al (1973). Combined arterial dilatation and femorofemoral bypass for limb salvage. Surg Gynecol Obstet 137, 409–12.
  18. Primasari R , Hernaningsih Y , Kahar H, et al (2022). Acute limb ischemia due to arterial thrombosis in a patient with COVID-19 pneumonia: A case report. Acta Med Indones 54, 4-43.
  19. Scheinert D, Schmidt A (2011). Techniques for crossing iliac and aortoiliac CTOs. Endovasc Today, 39–43.
  20. Steg PG, Bhatt DL, Wilson PWF, et al (2007). One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 297, 1197.
  21. Stone DH, Cambria RP (2005). Iliac surgical options. Endovasc Today, 52–4.
  22. Stoyioglou A, Jaff MR (2004). Medical treatment of peripheral arterial disease: A comprehensive review. J Vasc Interv Radiol 15, 1197–207.
  23. Tendera M, Aboyans V, Bartelink M-L, et al (2011). ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J 32, 2851–906.
  24. Thomas SD, Lennox AF, Varcoe RL (2015). Hybrid surgery techniques for the treatment of critical limb ischemia. Endovasc Today, 48–54.
  25. Uccioli L, Meloni M, Izzo V, et al (2018). Critical limb ischemia: Current challenges and future prospects. Vasc Health Risk Manag Volume 14, 63–74.
  26. Zhou M, Huang D, Liu C, et al (2014). Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease. Clin Interv Aging 22, 1595–603.
  27. Zou J, Xia Y, Yang H, et al (2012). Hybrid endarterectomy and endovascular therapy in multilevel lower extremity arterial disease involving the femoral artery bifurcation. Int Surg 97, 56–64.