Division of Vascular Surgery, VA Western NY Healthcare System, Buffalo, NY 14215, USA.
J Vasc Surg. 2010 Jun;51(6):1425-1435.e1. doi: 10.1016/j.jvs.2010.01.092.
Hybrid reconstructions have been increasingly used for multilevel revascularization procedures as surgeons have embraced endovascular interventions. The goal of this study is to define the role of simple and complex hybrid techniques in patients who need multilevel revascularization.
All patients undergoing arterial revascularization (endovascular [EV], open, hybrid) between June 2001 and May 2008 were included. Hybrid procedures were stratified as simple (sHYBRID group) when the endovascular-treated segment was TransAtlantic Society Consensus II (TASC) A/B, and complex (cHYBRID group), when TASC C/D.
Of the 654 patients, 770 limbs (67% critical limb ischemia), 226 (29%) had open, 436 (57%) had endovascular, and 108 (14%) had hybrid procedures (56 sHYBRID, 52 cHYBRID). The HYBRID group was more likely to have hypertension, chronic obstructive pulmonary disease, American Society of Anesthesia (ASA) 4, and aortoiliac reconstructions, with more ASA 4 in the cHYBRID than the sHYBRID group. Length of stay in the HYBRID group was significantly longer than the EV group, but less than open-treated groups. Endovascular intervention was performed for inflow in 85%, for runoff in 5%, and for both inflow and runoff in the remaining 10% of hybrid cases. Eleven (20%) sHYBRID cases were staged, while all cHYBRID cases were performed simultaneously. Femoral endarterectomy was more frequent in cHYBRID (75% vs 23% in sHYBRID), infrainguinal bypass (17% vs 55%) was more common in sHYBRID, the remainder being femoro-femoral bypasses (8% vs 21%). Endovascular procedures were primarily iliac interventions (91% in sHYBRID, 88% in cHYBRID). Thirty-day myocardial infarction/death rate was significantly higher in the HYBRID than the EV group, with no difference within the HYBRID group. The patency rates were similar in the sHYBRID and cHYBRID groups, and comparable to the endovascular and open treated patients with similar disease complexity. Limb salvage in patients who presented with critical limb ischemia was better in the cHYBRID group than other groups. Overall survival was similar in all groups.
Complex and simple hybrid procedures enable multilevel revascularizations in high-risk patients with comparable patency and limb salvage. Femoral endarterectomy plays a central role, especially in complex hybrid repairs. An increase in perioperative morbidity and mortality was observed in the hybrid group, likely due to attempting revascularization in higher risk patients.
随着外科医生接受血管内介入治疗，杂交重建术已越来越多地用于多节段血运重建手术。本研究的目的是确定在需要多节段血运重建的患者中，单纯和复杂杂交技术的作用。
纳入 2001 年 6 月至 2008 年 5 月期间接受动脉血运重建（血管内 [EV]、开放、杂交）的所有患者。当腔内治疗的节段为跨大西洋共识 II 期（TASC）A/B 时，将杂交手术分为单纯（sHYBRID 组），当腔内治疗的节段为 TASC C/D 时，将杂交手术分为复杂（cHYBRID 组）。
654 例患者中，770 条肢体（67%为严重肢体缺血），226 例（29%）行开放手术，436 例（57%）行血管内治疗，108 例（14%）行杂交手术（56 例 sHYBRID，52 例 cHYBRID）。HYBRID 组更可能患有高血压、慢性阻塞性肺疾病、美国麻醉医师协会（ASA）4 级和主髂动脉重建，cHYBRID 组比 sHYBRID 组的 ASA 4 级更多。HYBRID 组的住院时间明显长于 EV 组，但短于开放治疗组。腔内治疗的入流 85%，流出 5%，流入和流出各 10%。11 例（20%）sHYBRID 病例分期，而所有 cHYBRID 病例均同时进行。cHYBRID 中更常见股动脉内膜切除术（75%比 sHYBRID 中的 23%），sHYBRID 中更常见下肢旁路（17%比 55%），其余为股股旁路（8%比 21%）。腔内手术主要为髂动脉介入（sHYBRID 中的 91%，cHYBRID 中的 88%）。HYBRID 组的 30 天心肌梗死/死亡率明显高于 EV 组，但 HYBRID 组内无差异。sHYBRID 和 cHYBRID 组的通畅率相似，与类似疾病严重程度的血管内和开放治疗患者相似。严重肢体缺血患者的肢体挽救率在 cHYBRID 组优于其他组。所有组的总生存率相似。
复杂和简单的杂交手术可使高危患者进行多节段血运重建，其通畅率和肢体挽救率相当。股动脉内膜切除术起着核心作用，尤其是在复杂的杂交修复中。杂交组观察到围手术期发病率和死亡率增加，这可能是由于在风险更高的患者中尝试血运重建。
