Rapid increase in hybrid surgery for the treatment of peripheral artery disease in the Vascular Quality Initiative database

• Published in: Journal of vascular surgery 2020-09, Vol.72 (3), p.977-986.e1
• Main Authors: Fereydooni, Arash, Zhou, Bin, Xu, Yunshan, Deng, Yanhong, Dardik, Alan, Ochoa Chaar, Cassius Iyad
• Format: Article
• Language: English
• Subjects: Aged; Amputation; Combined Modality Therapy - trends; Databases, Factual; Endarterectomy - adverse effects; Endarterectomy - trends; Endovascular Procedures - adverse effects; Endovascular Procedures - trends; Female; Femoral Artery - diagnostic imaging; Femoral Artery - physiopathology; Femoral Artery - surgery; Femoropopliteal disease; Humans; Hybrid surgery; Limb Salvage; Lower extremity revascularization; Male; Middle Aged; National trends; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - surgery; Popliteal Artery - diagnostic imaging; Popliteal Artery - physiopathology; Popliteal Artery - surgery; Postoperative Complications - therapy; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Grafting - adverse effects; Vascular Grafting - trends; Vascular Patency; Vascular Quality Initiative
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2019.11.041

Advances in technology have increased the use of endovascular therapy for lower extremity revascularization (LER), but the impact on hybrid surgery has not been studied. This study aims to (1) investigate the contemporary national trends in frequency of hybrid LER and (2) compare the outcomes of open bypass (BYP) and hybrid surgery for isolated femoropopliteal revascularization. Using the national Vascular Quality Initiative database from 2010 to 2017, all patients receiving bypass or hybrid LER for PAD were identified. A trend of all hybrid LER compared with open LER was obtained. Next, only patients who underwent hybrid or open isolated femoropopliteal LER were identified. Patients treated with hybrid surgery underwent femoral endarterectomy and antegrade endovascular intervention of the femoropopliteal vessels (HYB), whereas patients treated with BYP underwent femoral endarterectomy and femoropopliteal bypass. These two groups of patients were matched based on age, gender, race, indication, ambulatory status, emergency status, diabetes, hypertension, coronary artery disease, chronic obstructive pulmonary disease, and hemodialysis. Patient characteristics and the perioperative and 1-year outcomes of the two groups were compared. The overall rate of hybrid LER procedures increased from 6.1% in 2010 to 32% in 2017 (P = .03). Hybrid LER was significantly more commonly used in patients with claudication (47%) and BYP surgery was used in patients with tissue loss (38.5%; P = .019). There were 456 HYB and 2665 BYP for isolated femoropopliteal revascularization. After propensity matching, the cohort comprised 425 patients in each group. HYB was associated with lower rate of myocardial infarction (1.9% vs 5.7%; P = .005) and renal complications (2.1% vs 6.7%; P = .003), length of stay (4.7 vs 6.1 days; P = .001), and higher rate of discharge to home (90.8% vs 81.4%; P < .001) compared with BYP. There was no significant difference in 30-day mortality (HYB 1.5% vs BYP, 2.5%; P = .44). The 1-year outcomes comparison suggested that patients in the BYP group had a higher likelihood of improvement in ambulatory status compared with patients in HYB group (16.7% vs 7.7%; P = .044). However, Kaplan-Meier analysis showed no difference in overall survival (P = .13) or amputation-free survival (P = .057) between the two groups. There was no statistical difference in graft patency, limb loss, or secondary interventions. Hybrid LER for PAD has been increasingly used and accou