Combination of open and endovascular procedures of the femoral artery
An effective method for treating chronic occlusions of the superficial femoral artery (SFA) in the treatment of PAD is femoropopliteal bypass surgery, with which limb salvage rates between 62 and 95% can be achieved [1-4]. Endovascular therapy with percutaneous transluminal angioplasty (PTA) of SFA stenoses also has – assuming unobstructed inflow – patency rates between 49 and 89% [5-8].
In the therapy of PAD, one of the most frequently performed open procedures is femoral TEA and profundoplasty, with which very good results are achieved, especially in stage II of PAD. The importance of revascularization of the profunda femoris artery was already reported in 1961 [9].
Conventional vascular surgical procedures can be combined with endovascular angioplasty procedures. One of the main indications for a simultaneous endovascular and open surgical hybrid procedure is the arteriosclerotically obliterated femoral bifurcation with simultaneous stenosis of the iliac artery and/or the femoropopliteal outflow tract [10]. Common hybrid procedures combine femoral TEA with angioplasty of the inflow (PTA/stent of the iliac artery), of the outflow (PTA of the SFA), or both [11, 12, 13]. Possible other combinations are, for example, PTA of the SFA and bypass, PTA of the iliac artery and femoral crossover bypass [11, 14, 15].
The results of hybrid procedures largely correspond to the results of open vascular surgery with limb salvage of about 80% after three years with low periprocedural risks [11-15]. However, a slightly lower patency rate of aorto-iliac hybrid procedures has also been reported [16].
Advantages for the patient are the minimization of the procedure or the operative trauma as well as the avoidance of a primary bypass graft. Hybrid procedures offer the possibility of performing a simultaneous multi-segment reconstruction in patients who are unsuitable for bypass procedures or have a high perioperative risk [17].