PMID- 35184612
OWN - NLM
STAT- MEDLINE
DCOM- 20230328
LR  - 20230403
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 30
IP  - 2
DP  - 2023 Apr
TI  - Distal Endarterectomy Combined With Endovascular Proximal Treatment: The Hybrid 
      DEEP Retrograde Technique for High-Complexity Infrainguinal Disease.
PG  - 232-240
LID - 10.1177/15266028221079766 [doi]
AB  - Purpose: We present a hybrid technique for the treatment of chronic 
      limb-threatening ischemia (CLTI) due to complex, multilevel infrainguinal 
      disease. It consists of an open distal endarterectomy combined with endovascular 
      proximal treatment (the DEEP technique). Materials and Methods: This was a 
      prospective cohort study. Thirty-three limbs (30 patients) were treated. Main 
      inclusion criteria were absence of significant disease in femoral bifurcation 
      associated with a complex infrainguinal pattern. This approach was specially 
      considered in absence of suitable vein for bypass, obesity, hostile groin, and 
      overall high surgical risk. Results: Mean age was 72.8 +/- 10 years (ranging 
      50-93). Most cases presented with severe limb threatening onset (90.9% Rutherford 
      >4 and 81.8% WIfi >3) due to high-complexity infrainguinal disease pattern 
      (Global Limb Anatomic Staging System [GLASS] stage III) in 31/33 (93.9%), chronic 
      total occlusions (CTOs) in 24/33 (72.7%), and severe calcification (Peripheral 
      Arterial Calcium Scoring System [PACSS] grade 4) in 22/33 (66.6%). Mean lesion 
      length was 228.2 mm +/- 83 (ranging 40-340 mm). In all procedures, a covered-stent 
      (25 cm length Viabahn) was implanted in a retrograde fashion as the endovascular 
      component. Effective revascularization was achieved in all cases, showing 
      significant clinical and hemodynamic improvement (median pre- and postprocedure 
      ankle-brachial index [ABI]: 0.3 and 0.9, respectively). Results at 12 months 
      follow-up were as follows: 93.9% limb salvage ratio, 75.7% primary patency, 84.6% 
      assisted primary patency, and 90.9% secondary patency. Major adverse limb events 
      (MALE) and cardiovascular events (MACE) occurred in 8/33 (24.2%) and 2/33 (6%), 
      respectively. Mean length of postoperative stay was 7.5 +/- 6.92 days (3-27). 
      Conclusion: This less invasive hybrid technique has promising short-term results 
      for limb salvage and it is worth to be included in vascular armamentarium for 
      CLTI revascularization in selected patients.
FAU - Garcia Dominguez, Luis J
AU  - Garcia Dominguez LJ
AUID- ORCID: 0000-0002-0010-6345
AD  - Vascular Surgery Department, Hospital Universitario y Politecnico la Fe, 
      Valencia, Spain.
FAU - Ramos Moreno, Irene
AU  - Ramos Moreno I
AD  - Vascular Surgery Department, Hospital Universitario y Politecnico la Fe, 
      Valencia, Spain.
FAU - Martinez Lopez, Rafael
AU  - Martinez Lopez R
AUID- ORCID: 0000-0002-7044-258X
AD  - Vascular Surgery Department, Hospital Universitario y Politecnico la Fe, 
      Valencia, Spain.
FAU - Ribe Bernal, Lucas
AU  - Ribe Bernal L
AD  - Vascular Surgery Department, Hospital Universitario y Politecnico la Fe, 
      Valencia, Spain.
FAU - Hernandez Sanfelix, Ana
AU  - Hernandez Sanfelix A
AD  - Vascular Surgery Department, Vascular Diagnostic Laboratory, Hospital 
      Universitario y Politecnico la Fe, Valencia, Spain.
FAU - Miralles Hernandez, Manuel
AU  - Miralles Hernandez M
AUID- ORCID: 0000-0001-8340-8172
AD  - Head of Vascular Surgery Department, Hospital Universitario y Politecnico la Fe, 
      Valencia, Spain.
LA  - eng
PT  - Journal Article
DEP - 20220221
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - Aged
MH  - Aged, 80 and over
MH  - *Endovascular Procedures/adverse effects/methods
MH  - Prospective Studies
MH  - *Peripheral Arterial Disease/diagnostic imaging/therapy
MH  - Treatment Outcome
MH  - Ischemia/diagnostic imaging/therapy
MH  - Vascular Patency
MH  - Risk Factors
MH  - Endarterectomy/adverse effects
MH  - Limb Salvage/adverse effects
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Global Limb Anatomic Staging System (GLASS)
OT  - chronic limb-threatening ischemia (CLTI)
OT  - hybrid revascularization
OT  - retrograde technique
EDAT- 2022/02/22 06:00
MHDA- 2023/03/28 16:48
CRDT- 2022/02/21 05:34
PHST- 2023/03/28 16:48 [medline]
PHST- 2022/02/22 06:00 [pubmed]
PHST- 2022/02/21 05:34 [entrez]
AID - 10.1177/15266028221079766 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2023 Apr;30(2):232-240. doi: 10.1177/15266028221079766. Epub 
      2022 Feb 21.