Hybrid endarterectomy in common femoral artery with endovascular femoropopliteal revascularization in TASC C and D patients

초록

Purpose: Hybrid common femoral artery (CFA) endarterectomy with femoropopliteal (FP) revascularization have the advantages such as avoiding mortality and morbidity. However hybrid surgery showed lower patency rates than open FP bypass. The purpose of our study was to compare the postoperative complication and clinical results between hybrid CFA endarterectomy with endovascular FP revascularization and FP bypass. Material and methods: A total of 65 patients with FP occlusive disease involving CFA were included in this study at our hospital from January 2013 to December 2017 and retrospectively analyzed. Of these, 37 had hybrid surgery (CFA endarterectomy and FP revascularization) and 28 had open FP bypass. We examined patient’s characteristics, procedural detail and follow up data. We compared to primary and secondary patency rate between hybrid and bypass group. Results: We underwent 37 hybrid surgeries (CFA endarterectomy with PTA (n=28) or stent (n=9) ) and 28 FP bypass surgeries with saphenous vein graft (n=18) and PTFE graft (n=10). There is statistically no difference in patient characteristics between two groups including popliteal involvement (Hybrid group(n=14) vs. bypass group(n=11) p=0.55). There was 1 technical failure in postoperative immediate occlusion in hybrid groups. Operative time of hybrid group (mean±sd ,113±24 mins) is shorter than of bypass group (mean±sd ,166±32) (p<0.01). The primary patency rates were 70 % and 76% (Log rank = 0.742) and the secondary patency rates were 80% and 82% (P = 0.813) at 3 years for hybrid and surgery group, respectively. Conclusion: Hybrid treatment provide feasible and effective management of selected patients with FP occlusive disease involving CFA.