İleri periferik arter hastalığı olan hastalarda femoroiliak tıkayıcı hastalık için tek aşamalı hibrit revaskülarizasyonun uygulanabilirliği ve erken sonuçlarıMustafa Aldag, Nicoline Jochmann-SchiekVasküler ve Endovasküler Cerrahi Bölümü, Regio Kliniği, Elmshorn, Almanya
AMAÇ: Kombine femoroiliak tıkayıcı hastalığı olan hastalarda, perikardiyal yama anjiyoplasti ile ortak femoral endarterektomi ve ipsilateral iliak arterlerin endovasküler rekanalizasyonundan oluşan tek aşamalı hibrit revaskülarizasyonun uygulanabilirliğini ve erken sonuçlarını değerlendirmek.
YÖNTEMLER: Ocak 2022 ile Ekim 2025 tarihleri arasında, kurumumuzda eşzamanlı tek aşamalı hibrit revaskülarizasyon uygulanan, çok seviyeli iliofemoral periferik arter hastalığı (PAD) olan ardışık hastalar retrospektif olarak analiz edildi. Hibrit strateji, sığır perikardiyal yama anjiyoplasti ile ortak femoral endarterektomi ve stent implantasyonu ile veya stent implantasyonu olmadan balon anjiyoplasti kullanılarak ipsilateral iliak arterlerin intraoperatif anjiyografi kılavuzlu endovasküler rekanalizasyonunu içermekteydi; endikasyon olduğunda tel kılavuzlu iliak embolektomi uygulandı. Ameliyat öncesi değerlendirme, bilgisayarlı tomografi anjiyografi (1 mm kesit kalınlığı) ve renk kodlu dupleks ultrasonografiyi içeriyordu. Hastalar en az üç ay boyunca klinik değerlendirme ve dupleks ultrason ile takip edildi. Birincil sonlanım noktası, planlanan hibrit prosedürün birincil teknik başarısıydı. İkincil sonlanım noktaları arasında ameliyat sonrası komplikasyonlar, hastanede kalış süresi, üç aylık iliak stent açıklığı, mortalite ve amputasyonsuz sağkalım yer alıyordu.
SONUÇLAR: Yirmi sekiz hasta analiz için uygun bulundu. Yaş ortalaması 73 (IQR: 14,5) idi ve %64,3'ü erkekti. Hastaların çoğu ileri evre hastalıkla başvurdu. Anahtar Kelimeler: Periferik arter hastalığı, hibrid prosedür, revaskülarizasyon, endovasküler.
Feasibility and early outcomes of single-stage hybrid revascularization for femoroiliac occlusive disease in patients with advanced peripheral arterial diseaseMustafa Aldag, Nicoline Jochmann-SchiekDepartment of Vascular and Endovascular Surgery, Clinic of Regio, Elmshorn, Germany
OBJECTIVE: To assess the feasibility and early outcomes of single-stage hybrid revascularization consisting of common femoral endarterectomy with pericardial patch angioplasty and endovascular recanalization of the ipsilateral iliac arteries in patients with combined femoroiliac occlusive disease.
METHODS: Between January 2022 and October 2025, consecutive patients with multilevel iliofemoral peripheral artery disease (PAD) who underwent simultaneous single-stage hybrid revascularization at our institution were retrospectively analyzed. The hybrid strategy comprised common femoral endarterectomy with bovine pericardial patch angioplasty and intraoperative angiography-guided endovascular recanalization of the ipsilateral iliac arteries using balloon angioplasty with or without stent implantation; wire-guided iliac embolectomy was performed when indicated. Preoperative assessment included computed tomography angiography (1-mm slice thickness) and color-coded duplex ultrasonography. Patients were followed for at least three months with clinical assessment and duplex ultrasound. The primary endpoint was primary technical success of the planned hybrid procedure. Secondary endpoints included postoperative complications, length of hospital stay, three-month iliac stent patency, mortality, and amputation-free survival.
RESULTS: Twenty-eight patients were available for analysis. The median age was 73 (IQR: 14.5) years, and 64.3% were male. Most patients presented with advanced disease (Fontaine III–IV, 85.8%), and 60.7% had rest pain. Primary technical success was achieved in 85.7%. Bailout femorofemoral crossover bypass was required in 10.7%, and staged endovascular completion was planned in one patient. Iliac stenting was performed in 67.9%; wire-guided iliac embolectomy achieved thrombus extraction in 78.6% of attempted cases. The median length of stay was 10.5 (IQR: 7) 13.4 days. Wound-healing disorders occurred in 7.1%. At three months, iliac stent patency was 100% and mortality was 0%. Amputation-free survival was 82.1%, with minor and major amputations in 10.7% and 7.1%, respectively.
CONCLUSION: Single-stage hybrid revascularization for femoroiliac occlusive disease in patients with advanced PAD was feasible and was associated with favorable early outcomes. Larger prospective studies with longer follow-up are needed to confirm durability and comparative effectiveness. [NCI-2026-1-9] Keywords: Peripheral arterial disease, hybrid procedure, revascularization, endovascular.
Sorumlu Yazar: Mustafa Aldag
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