Open surgery versus hybrid endovascular treatment for complete revascularization in infrarenal aortoiliac occlusive disease

Abstract

BACKGROUND: We aimed to retrospectively investigate the clinical effectiveness of hybrid treatment (non-laparotomy surgery with endovascular intervention; group 2) versus open laparotomy surgery (aorto-bi-iliac/femoral bypass; group 1) for synchronous complete revascularization in infrarenal aortoiliac occlusive disease (AIOD). METHODS: From January 2010 to December 2016, 95 patients were enrolled (group 1: 46, group 2: 49; mean follow-up period, 39.7 months). The patency and limb salvage rates for The Atlantic Inter Society Consensus Classification (TASC) II C and D patients were analyzed. RESULTS: The patients were predominantly male (87.4%), and their mean age was 69.76 years. There were no significant differences in demographics; the most common risk factor and symptoms were arterial hypertension and claudication in both groups. Only one perioperative death was observed in group 1. The 1-, 2- and 3-year primary patency rates were 97.8%, 97.8%, and 94.8% in group 1, and 87.0%, 75.5%, and 69.2% in group 2, respectively, which were significantly different (P=0.013). However, the secondary patency rates were not significantly different (P=0.708); the 1-, 2- and 3-year limb salvage rates for TASC II C and D patients were also not significantly different (group 1: 100%, 100%, and 96.7%, group 2: 100%, 100%, and 89.5%, respectively, P=0.182). CONCLUSIONS: Although our study showed lower primary patency rate in hybrid treatment than in open laparotomy surgery, the limb salvage rates were not significantly different. Early mortality rate was lower with hybrid endovascular treatment. Therefore, non-laparotomy surgery with endovascular interventional treatment could be considered as alternative treatment for synchronous complete revascularization in high-risk patients.