Staged versus nonstaged elective hybrid iliofemoral revascularization - analysis of ten years of prospective data

Johan Nyman; Julien Hasselmann; Christina Monsen; Stefan Acosta

doi:10.1016/j.avsg.2024.05.036

Staged versus nonstaged elective hybrid iliofemoral revascularization - analysis of ten years of prospective data

Ann Vasc Surg. 2024 Jul 14:S0890-5096(24)00423-0. doi: 10.1016/j.avsg.2024.05.036. Online ahead of print.

Authors

Johan Nyman¹, Julien Hasselmann², Christina Monsen³, Stefan Acosta⁴

Affiliations

¹ Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden. Electronic address: johan.nyman@med.lu.se.
² Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
³ Department of Allied Health Professions, Skane University Hospital, Malmö, Sweden.
⁴ Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.

PMID: 39009127
DOI: 10.1016/j.avsg.2024.05.036

Abstract

Background: Reports of large series of hybrid iliofemoral revascularization for chronic lower limb ischemia are scarce. The aims of this study were to evaluate outcomes for staged and nonstaged procedures, and to evaluate risk factors for outcomes at 90 days.

Methods: Patients were consecutively included between 2013 and 2023. Surgical site infection (SSI) was defined by the ASEPSIS criteria and major adverse limb events (MALE) as onset of acute or continuing or worsening chronic limb ischemia or major amputation. Factors associated with outcomes were tested in a multivariable logistic regression analysis and expressed in odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Patients undergoing nonstaged procedures (n = 124) had higher Trans-Atlantic Inter-Society Consensus (TASC) class representing anatomical occlusive complexity, more often through-and through femoral guidewire access, more endoprosthesis, more covered stents, longer procedure time with open groin wounds, and less contralateral femoral access, than those undergoing staged procedures (n = 31). The median time interval between the staged procedures was 1 day, and iliac stenting was done first in 77%. The median in-hospital stay was nonsignificantly longer in staged procedure (8 vs. 6 days, P = 0.053). The overall SSI and MALE rates were 25.8% and 20.0%, respectively, without differences between groups. Diabetes mellitus (OR 3.7, 95% CI 1.2-7.2]) and presence of a foot ulcer (OR 3.7, 95% CI [1.5-9.4]) were independently associated with MALE at 90 days. Postoperative hyperglycemia was nonsignificantly associated with SSI (OR 2.1 (95% CI 1.0-4.5), P = 0.066) in multivariable analysis.

Conclusions: The risks of SSI and MALE after elective hybrid iliofemoral revascularization were high. There appears to be no benefit in performing staged as opposed to nonstaged procedures. The extent of iliofemoral occlusive disease according to the TASC classification had little influence on outcomes whereas diabetes mellitus and presence of a foot ulcer had greater impact on MALE.