Hybrid Treatment in Patients with Peripheral Arterial Disease

Hybrid treatment, combining open surgical and endovascular techniques in a single session, has become an essential approach for patients with multilevel peripheral arterial disease (PAD). This study evaluates outcomes of hybrid reconstructions performed at the Clinic of Vascular Surgery, Faculty of Medicine, Pavol Jozef Safarik University, and the East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia. A retrospective analysis included 202 patients treated between 2017 and 2023 for multisegmental atherosclerotic disease of the lower limbs. All underwent common femoral artery (CFA) endarterectomy combined with additional surgical or endovascular procedures targeting the iliac or femoropopliteal segments. Six procedural groups were defined according to anatomical distribution and type of reconstruction. Primary, primary-assisted, and secondary patency, as well as Major Adverse Limb Events (MALE) and Major Adverse Cardiovascular Events (MACE), were analyzed during 1-, 6-, and 12-month follow-up. The overall technical success rate was 93.1%. Thirty-day morbidity was low, with 14 conversions (6.9%) to open surgery due to intraoperative complications. After 12 months, the best outcomes were achieved in patients who underwent remote endarterectomy of the external iliac artery followed by endovascular treatment (primary patency 95.7%, primary-assisted 98.6%, secondary 100%). In the femoropopliteal group, one-year primary, primary-assisted, and secondary patency were 71.4%, 85.7%, and 92.9%, respectively, for combined remote endarterectomy and stenting. Statistically significant differences (p < 0.05) were observed in primary and primary-assisted patency between iliac-region subgroups, favoring remote endarterectomy-based reconstructions. The incidence of MALE was 6.9% and MACE 4.5% at one year, with seven deaths (3.5%) mostly due to cardiovascular causes. Hybrid treatment of PAD, particularly combining CFA endarterectomy with remote endarterectomy and adjunctive endovascular intervention, provides excellent technical success and satisfactory patency with acceptable morbidity and mortality. This integrated strategy represents a durable and less invasive alternative to extensive open reconstruction, especially for high-risk patients with multilevel disease.