Open surgery versus hybrid endovascular treatment for complete revascularization in infrarenal aortoiliac occlusive disease

Won-Min Jo, Byoung Ju Min, Jinwook Hwang, Jae Seung Shin

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We aimed to retrospectively investigate the clinical effectiveness of hybrid treatment (non-laparotomy surgery with endovascular intervention; group 2) versus open laparotomy surgery (aorto-bi-iliac/femoral bypass; group 1) for synchronous complete revascularization in infrarenal aortoiliac occlusive disease (AIOD). METHODS: From January 2010 to December 2016, 95 patients were enrolled (group 1:46, group 2:49; mean follow-up period, 39.7 months). The patency and limb salvage rates for The Atlantic Inter Society Consensus Classification (TASC) II C and D patients were analyzed. RESULTS: The patients were predominantly male (87.4%), and their mean age was 69.76 years. There were no significant differences in demographics; the most common risk factor and symptoms were arterial hypertension and claudication in both groups. Only one perioperative death was observed in group 1. The 1-, 2- and 3-year primary patency rates were 97.8%, 97.8%, and 94.8% in group 1, and 87.0%, 75.5%, and 69.2% in group 2, respectively, which were significantly different (P=0.013). However, the secondary patency rates were not significantly different (P=0.708); the 1-, 2- and 3-year limb salvage rates for TASC II C and D patients were also not significantly different (group 1:100%, 100%, and 96.7%, group 2:100%, 100%, and 89.5%, respectively, P=0.182). CONCLUSIONS: Although our study showed lower primary patency rate in hybrid treatment than in open laparotomy surgery, the limb salvage rates were not significantly different. Early mortality rate was lower with hybrid endovascular treatment. Therefore, non-laparotomy surgery with endovascular interventional treatment could be considered as alternative treatment for synchronous complete revascularization in high-risk patients.

Original languageEnglish
Pages (from-to)294-301
Number of pages8
JournalItalian Journal of Vascular and Endovascular Surgery
Volume25
Issue number4
DOIs
Publication statusPublished - 2018 Dec 1

Fingerprint

Limb Salvage
Laparotomy
Therapeutics
Thigh
Demography
Hypertension
Mortality

Keywords

  • Arterial occlusive diseases
  • Endovascular procedures
  • Laparotomy

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

@article{8d4fd438585f40e1b9389ea5f53a4e06,
title = "Open surgery versus hybrid endovascular treatment for complete revascularization in infrarenal aortoiliac occlusive disease",
abstract = "BACKGROUND: We aimed to retrospectively investigate the clinical effectiveness of hybrid treatment (non-laparotomy surgery with endovascular intervention; group 2) versus open laparotomy surgery (aorto-bi-iliac/femoral bypass; group 1) for synchronous complete revascularization in infrarenal aortoiliac occlusive disease (AIOD). METHODS: From January 2010 to December 2016, 95 patients were enrolled (group 1:46, group 2:49; mean follow-up period, 39.7 months). The patency and limb salvage rates for The Atlantic Inter Society Consensus Classification (TASC) II C and D patients were analyzed. RESULTS: The patients were predominantly male (87.4{\%}), and their mean age was 69.76 years. There were no significant differences in demographics; the most common risk factor and symptoms were arterial hypertension and claudication in both groups. Only one perioperative death was observed in group 1. The 1-, 2- and 3-year primary patency rates were 97.8{\%}, 97.8{\%}, and 94.8{\%} in group 1, and 87.0{\%}, 75.5{\%}, and 69.2{\%} in group 2, respectively, which were significantly different (P=0.013). However, the secondary patency rates were not significantly different (P=0.708); the 1-, 2- and 3-year limb salvage rates for TASC II C and D patients were also not significantly different (group 1:100{\%}, 100{\%}, and 96.7{\%}, group 2:100{\%}, 100{\%}, and 89.5{\%}, respectively, P=0.182). CONCLUSIONS: Although our study showed lower primary patency rate in hybrid treatment than in open laparotomy surgery, the limb salvage rates were not significantly different. Early mortality rate was lower with hybrid endovascular treatment. Therefore, non-laparotomy surgery with endovascular interventional treatment could be considered as alternative treatment for synchronous complete revascularization in high-risk patients.",
keywords = "Arterial occlusive diseases, Endovascular procedures, Laparotomy",
author = "Won-Min Jo and Min, {Byoung Ju} and Jinwook Hwang and Shin, {Jae Seung}",
year = "2018",
month = "12",
day = "1",
doi = "10.23736/S1824-4777.18.01372-4",
language = "English",
volume = "25",
pages = "294--301",
journal = "Italian Journal of Vascular and Endovascular Surgery",
issn = "1824-4777",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "4",

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T1 - Open surgery versus hybrid endovascular treatment for complete revascularization in infrarenal aortoiliac occlusive disease

AU - Jo, Won-Min

AU - Min, Byoung Ju

AU - Hwang, Jinwook

AU - Shin, Jae Seung

PY - 2018/12/1

Y1 - 2018/12/1

N2 - BACKGROUND: We aimed to retrospectively investigate the clinical effectiveness of hybrid treatment (non-laparotomy surgery with endovascular intervention; group 2) versus open laparotomy surgery (aorto-bi-iliac/femoral bypass; group 1) for synchronous complete revascularization in infrarenal aortoiliac occlusive disease (AIOD). METHODS: From January 2010 to December 2016, 95 patients were enrolled (group 1:46, group 2:49; mean follow-up period, 39.7 months). The patency and limb salvage rates for The Atlantic Inter Society Consensus Classification (TASC) II C and D patients were analyzed. RESULTS: The patients were predominantly male (87.4%), and their mean age was 69.76 years. There were no significant differences in demographics; the most common risk factor and symptoms were arterial hypertension and claudication in both groups. Only one perioperative death was observed in group 1. The 1-, 2- and 3-year primary patency rates were 97.8%, 97.8%, and 94.8% in group 1, and 87.0%, 75.5%, and 69.2% in group 2, respectively, which were significantly different (P=0.013). However, the secondary patency rates were not significantly different (P=0.708); the 1-, 2- and 3-year limb salvage rates for TASC II C and D patients were also not significantly different (group 1:100%, 100%, and 96.7%, group 2:100%, 100%, and 89.5%, respectively, P=0.182). CONCLUSIONS: Although our study showed lower primary patency rate in hybrid treatment than in open laparotomy surgery, the limb salvage rates were not significantly different. Early mortality rate was lower with hybrid endovascular treatment. Therefore, non-laparotomy surgery with endovascular interventional treatment could be considered as alternative treatment for synchronous complete revascularization in high-risk patients.

AB - BACKGROUND: We aimed to retrospectively investigate the clinical effectiveness of hybrid treatment (non-laparotomy surgery with endovascular intervention; group 2) versus open laparotomy surgery (aorto-bi-iliac/femoral bypass; group 1) for synchronous complete revascularization in infrarenal aortoiliac occlusive disease (AIOD). METHODS: From January 2010 to December 2016, 95 patients were enrolled (group 1:46, group 2:49; mean follow-up period, 39.7 months). The patency and limb salvage rates for The Atlantic Inter Society Consensus Classification (TASC) II C and D patients were analyzed. RESULTS: The patients were predominantly male (87.4%), and their mean age was 69.76 years. There were no significant differences in demographics; the most common risk factor and symptoms were arterial hypertension and claudication in both groups. Only one perioperative death was observed in group 1. The 1-, 2- and 3-year primary patency rates were 97.8%, 97.8%, and 94.8% in group 1, and 87.0%, 75.5%, and 69.2% in group 2, respectively, which were significantly different (P=0.013). However, the secondary patency rates were not significantly different (P=0.708); the 1-, 2- and 3-year limb salvage rates for TASC II C and D patients were also not significantly different (group 1:100%, 100%, and 96.7%, group 2:100%, 100%, and 89.5%, respectively, P=0.182). CONCLUSIONS: Although our study showed lower primary patency rate in hybrid treatment than in open laparotomy surgery, the limb salvage rates were not significantly different. Early mortality rate was lower with hybrid endovascular treatment. Therefore, non-laparotomy surgery with endovascular interventional treatment could be considered as alternative treatment for synchronous complete revascularization in high-risk patients.

KW - Arterial occlusive diseases

KW - Endovascular procedures

KW - Laparotomy

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