The role of open access endovascular revascularization in treatment of critically ischemic lower limbs: a three-center 1-year experience

Abstract

Introduction Chronic limb-threatening ischemia (CLTI) is commonly produced by multilevel arterial tree affection. To correct its effect, multisegment revascularization was adopted. The use of hybrid revascularization includes the use of an open access to accomplish the endovascular part of the procedure. Sometimes, for technical issues, open access is used for only angioplasty. In thrombectomy, for acute ischemia, residual chronic lesion angioplasty is done. This, also, entails the use of open access for angioplasty. Aim To report and evaluate three-center work in open access endovascular therapy for lower limb CLTI and acute thrombotic ischemia. Patients and methods This prospective study included patients admitted to Vascular Surgery Unit, Faculty of Medicine, Alexandria University, Department of Vascular Surgery, Faculty of Medicine, Tanta University, and Department of Experimental and Clinical Surgery, Medical Research Institute, Alexandria University, from June 1, 2018, to May 31, 2019, treated by different endovascular modalities done through open surgical access and followed for 1 year. Results A total of 116 patients were included, comprising 86.2% men and 13.8%women. The mean±SD age was 59.74±7.82 years. A total of 98 (84.5%) patients had CLTI and 18 (15.5%) had acute thrombotic ischemia. All acute patients had hybrid thrombectomy and completion angioplasty with excellent outcome. For patients with CLTI, 30 (25.9%) had open access angioplasty only and the rest 86 (74.1%) patients had hybrid endosurgical revascularization. Technical success was 94.8% for all cases. The primary and secondary patency rates were 67.6 and 76.5%, respectively, at 6 months and 52.7 and 62.6%, respectively, at 1 year, with an acceptable limb salvage rate of 91.2% at 1 year. Conclusion Open access endovascular procedures are feasible maneuvers allowing multisegment arterial disease treatment in both chronic and acute occlusions, offering good tools for the surgeon to minimize invasive approaches with acceptable patency and good limb salvage but should be reserved for critical ischemia owing to their complex nature.