Department of Vascular Surgery, University Hospital LMU Munich, Munich, Germany -
Department of Vascular Surgery, University Hospital LMU Munich, Munich, Germany.
J Cardiovasc Surg (Torino). 2023 Jun;64(3):255-261. doi: 10.23736/S0021-9509.23.12672-3.
Hybrid revascularization procedures for acute limb ischemia (ALI) are becoming increasingly common, bibliographic data on outcomes is however sparse.
Single-center, retrospective study of consecutive patients with ALI that underwent either surgical treatment (ST) or hybrid treatment (HT) between January 2015 and December 2021. The composite outcome of amputation-free survival (AFS) was the primary endpoint. Technical success, overall survival, amputation, and re-intervention rates were the secondary endpoints.
During the study period 266 patients (mean age 70.2±14.5 years; 49.6% males) were treated for ALI, 67.3% undergoing ST and 32.7% HT. HT was more frequently used in patients with a previous vascular intervention in the index limb (38/87; 43.7% HT vs. 40/179; 22.3% ST, P=0.001), a stent- or stent graft-occlusion (16/87; 18.4% HT vs. 10/179; 5.6% ST, P=0.002) and/or a bypass occlusion (16/87; 18.4% HT vs. 16/179; 8.9% ST, P=0.043). Technical success was higher in the OR group (75/87; 86.2% HT vs. 173/179; 96.6% ST, P=0.003). Amputation-free survival rate during follow-up (43/87; 49.4% HT vs. 94/179; 52.5% ST, HR 0.76, 95% CI: 0.49 to 1.18, P=0.22) and overall survival (32/87; 36.8% HT vs. 84/179; 46.9% ST, HR 0.81, 95% CI: 0.49 to 1.34, P=0.41) were comparable between the two groups. No statistical differences were observed between the groups regarding major amputation (19/87; 21.8% HT vs. 15/179; 8.4% ST, HR 0.85, 95% CI: 0.33 to 2.23, P=0.74) or reintervention during follow-up (45/87; 51.7% HT vs. 65/179; 36.3% ST, HR 0.92, 95% CI: 0.56 to 1.51, P=0.73).
Hybrid and open surgical treatments showed comparable results in our cohort, even though significantly more patients undergoing HT presented with stent and bypass occlusions rather than de-novo lesions.
急性肢体缺血（ALI）的杂交血运重建术越来越常见，但关于其结果的文献数据却很少。
这是一项单中心、回顾性研究，连续纳入了 2015 年 1 月至 2021 年 12 月期间因 ALI 接受手术治疗（ST）或杂交治疗（HT）的患者。无截肢生存率（AFS）是主要终点。技术成功率、总生存率、截肢率和再干预率是次要终点。
在研究期间，266 名（平均年龄 70.2±14.5 岁；男性 49.6%）ALI 患者接受了治疗，67.3%接受了 ST，32.7%接受了 HT。在索引肢体中有既往血管介入史（38/87；43.7% HT 比 40/179；22.3% ST，P=0.001）、支架或支架移植物闭塞（16/87；18.4% HT 比 10/179；5.6% ST，P=0.002）和/或旁路闭塞（16/87；18.4% HT 比 16/179；8.9% ST，P=0.043）的患者中，HT 的应用更为频繁。OR 组的技术成功率更高（75/87；86.2% HT 比 173/179；96.6% ST，P=0.003）。在随访期间，HT 组的无截肢生存率（43/87；49.4% HT 比 94/179；52.5% ST，HR 0.76，95%CI：0.49 至 1.18，P=0.22）和总生存率（32/87；36.8% HT 比 84/179；46.9% ST，HR 0.81，95%CI：0.49 至 1.34，P=0.41）与 ST 组相当。两组间主要截肢（19/87；21.8% HT 比 15/179；8.4% ST，HR 0.85，95%CI：0.33 至 2.23，P=0.74）或随访期间再干预（45/87；51.7% HT 比 65/179；36.3% ST，HR 0.92，95%CI：0.56 至 1.51，P=0.73）方面无统计学差异。
在我们的研究队列中，杂交和开放手术治疗的结果相当，尽管 HT 组中接受治疗的患者支架和旁路闭塞的比例明显高于新发病变。
