Hybrid-based approach for pervasive occlusive disease of iliofemoral arteries

Aim: Simultaneous multilevel hybrid-based reconstructions using both endovascular and open femoral endartectomy merit the interest with the widespread adoption of these techniques by vascular surgeons. Here we presented our experience on hybrid-based approach to treat total occlusive iliofemoral lesions and study the technical success and mid-term results of combined femoral endarterectomy and endovascular treatment of iliac occlusion. Material and Methods: This retrospective single center study included patients with only total occlusion in the unilateral iliac artery. The patients underwent hybrid procedure–open femoral endarterectomy and endovascular revascularization of the external or common iliac artery- between 2016 and 2022. Statistical analysis was performed by using SPSS software version 25. Results: Totally 103 patients who underwent hybrid procedures for pervasive unilateral iliac artery occlusions were included in this study. Of the study cohort, 76% were male patients with a mean age of 74±8.7 years. Technical success rate was 89.3%. Acute myocardial infarction was the most common complication. The 30-day mortality was 7.8% (n=8) and all of them were in-hospital deaths. The survival rates of this cohort at 30 days, 6 months and 12 months were 92.2%, 88.1% and 83.7%, respectively. The primary patency at 30 days, 6 months, and 12 months were 98.1%, 96.6%, and 93.7%, respectively. Conclusion: The clinical and technical outcomes in this study suggest that the hybrid approach to pervasive iliofemoral occlusions, combining femoral endarterectomy and endovascular iliac revascularization, is an effective and applicable treatment in terms of patency rates and perioperative complications.