Hybrid Revascularization Combining Iliofemoral Endarterectomy and Iliac Stent Grafting for TransAtlantic Inter-Society Consensus C and D Aortoiliac Occlusive Disease

Juliet J. Ray, Sarah A. Eidelson, Charles A. Karcutskie, Jonathan P. Meizoso, Hilene DeAmorim, Lee J. Goldstein, John K Karwowski, Arash Bornak

Research output: Contribution to journalArticle

Abstract

Background: This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). Methods: A retrospective review was conducted in patients with TASC C and D AIOD involving the CFA and undergoing hybrid revascularization. Covered stents were used primarily. Demographics, indications for surgery, lesion classification, hospital length of stay (LOS), 30-day morbidity/mortality, hemodynamic and clinical success, and patency were assessed. Results: Thirty-six male patients (41 limbs), mean age 63.9 ± 6 years, were identified (TASC C = 39%, D = 61%). Indications for surgery were claudication (27%), rest pain (44%), and tissue loss (29%). A simultaneous adjunctive procedure (5 infrainguinal bypass, 3 superficial femoral artery stents) was performed in 22%. Thirty-day outcomes included 1 mortality (2.7%) and 2 reoperation (5.5%), 1 for femoral artery pseudoaneurysm and 1 for bilateral groin seroma. LOS was 4 days (interquartile range 3–6). All patients with available data experienced 30-day clinical and hemodynamic success. Mean follow-up was 23 months (range 1–79 months) with a primary patency of 85.4%. Cumulative primary assisted and secondary patency was 92.6%. The femoral patch repair was the most frequent site of reintervention (3/3). Mortality was 34% during the study period, and it was significantly higher in patients with tissue loss (57.1% vs. 14.8%, P = 0.01). Conclusions: The hybrid approach has low morbidity, mortality, and fast recovery. The use of covered stents/stent grafts provides good mid-term patency. Close follow-up with noninvasive imaging is paramount to avoid repair failure, in particular at the femoral patch repair site.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Endarterectomy
Stents
Femoral Artery
Length of Stay
Mortality
Thigh
Hemodynamics
Morbidity
Nociceptive Pain
Seroma
Groin
Iliac Artery
False Aneurysm
Reoperation
Extremities
Demography
Outcome Assessment (Health Care)
Transplants

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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Hybrid Revascularization Combining Iliofemoral Endarterectomy and Iliac Stent Grafting for TransAtlantic Inter-Society Consensus C and D Aortoiliac Occlusive Disease. / Ray, Juliet J.; Eidelson, Sarah A.; Karcutskie, Charles A.; Meizoso, Jonathan P.; DeAmorim, Hilene; Goldstein, Lee J.; Karwowski, John K; Bornak, Arash.

In: Annals of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Ray, Juliet J. ; Eidelson, Sarah A. ; Karcutskie, Charles A. ; Meizoso, Jonathan P. ; DeAmorim, Hilene ; Goldstein, Lee J. ; Karwowski, John K ; Bornak, Arash. / Hybrid Revascularization Combining Iliofemoral Endarterectomy and Iliac Stent Grafting for TransAtlantic Inter-Society Consensus C and D Aortoiliac Occlusive Disease. In: Annals of Vascular Surgery. 2018.
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abstract = "Background: This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). Methods: A retrospective review was conducted in patients with TASC C and D AIOD involving the CFA and undergoing hybrid revascularization. Covered stents were used primarily. Demographics, indications for surgery, lesion classification, hospital length of stay (LOS), 30-day morbidity/mortality, hemodynamic and clinical success, and patency were assessed. Results: Thirty-six male patients (41 limbs), mean age 63.9 ± 6 years, were identified (TASC C = 39{\%}, D = 61{\%}). Indications for surgery were claudication (27{\%}), rest pain (44{\%}), and tissue loss (29{\%}). A simultaneous adjunctive procedure (5 infrainguinal bypass, 3 superficial femoral artery stents) was performed in 22{\%}. Thirty-day outcomes included 1 mortality (2.7{\%}) and 2 reoperation (5.5{\%}), 1 for femoral artery pseudoaneurysm and 1 for bilateral groin seroma. LOS was 4 days (interquartile range 3–6). All patients with available data experienced 30-day clinical and hemodynamic success. Mean follow-up was 23 months (range 1–79 months) with a primary patency of 85.4{\%}. Cumulative primary assisted and secondary patency was 92.6{\%}. The femoral patch repair was the most frequent site of reintervention (3/3). Mortality was 34{\%} during the study period, and it was significantly higher in patients with tissue loss (57.1{\%} vs. 14.8{\%}, P = 0.01). Conclusions: The hybrid approach has low morbidity, mortality, and fast recovery. The use of covered stents/stent grafts provides good mid-term patency. Close follow-up with noninvasive imaging is paramount to avoid repair failure, in particular at the femoral patch repair site.",
author = "Ray, {Juliet J.} and Eidelson, {Sarah A.} and Karcutskie, {Charles A.} and Meizoso, {Jonathan P.} and Hilene DeAmorim and Goldstein, {Lee J.} and Karwowski, {John K} and Arash Bornak",
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AU - Ray, Juliet J.

AU - Eidelson, Sarah A.

AU - Karcutskie, Charles A.

AU - Meizoso, Jonathan P.

AU - DeAmorim, Hilene

AU - Goldstein, Lee J.

AU - Karwowski, John K

AU - Bornak, Arash

PY - 2018/1/1

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N2 - Background: This study examines the outcome of hybrid revascularization combining iliofemoral endarterectomy and iliac artery stenting using covered stents in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD) involving the common femoral artery (CFA). Methods: A retrospective review was conducted in patients with TASC C and D AIOD involving the CFA and undergoing hybrid revascularization. Covered stents were used primarily. Demographics, indications for surgery, lesion classification, hospital length of stay (LOS), 30-day morbidity/mortality, hemodynamic and clinical success, and patency were assessed. Results: Thirty-six male patients (41 limbs), mean age 63.9 ± 6 years, were identified (TASC C = 39%, D = 61%). Indications for surgery were claudication (27%), rest pain (44%), and tissue loss (29%). A simultaneous adjunctive procedure (5 infrainguinal bypass, 3 superficial femoral artery stents) was performed in 22%. Thirty-day outcomes included 1 mortality (2.7%) and 2 reoperation (5.5%), 1 for femoral artery pseudoaneurysm and 1 for bilateral groin seroma. LOS was 4 days (interquartile range 3–6). All patients with available data experienced 30-day clinical and hemodynamic success. Mean follow-up was 23 months (range 1–79 months) with a primary patency of 85.4%. Cumulative primary assisted and secondary patency was 92.6%. The femoral patch repair was the most frequent site of reintervention (3/3). Mortality was 34% during the study period, and it was significantly higher in patients with tissue loss (57.1% vs. 14.8%, P = 0.01). Conclusions: The hybrid approach has low morbidity, mortality, and fast recovery. The use of covered stents/stent grafts provides good mid-term patency. Close follow-up with noninvasive imaging is paramount to avoid repair failure, in particular at the femoral patch repair site.

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