A Hybrid Technique to Treat Iliofemoral Lesions Using a Covered Stent Associated with Open Femoral Repair

To describe a hybrid approach for complex iliofemoral lesions and report short-term and mid-term results. In this single-center retrospective study, all consecutive patients (n = 32, 36 limbs) who underwent hybrid repair of complex iliofemoral lesions between 2012 and 2017 using a conformable self-expandable covered stent for external iliac artery lesions and open repair of the common femoral artery were included. Lesions were responsible for claudication in 13 (36%) limbs, rest pain in 13 (36%) limbs and tissue loss in 10 (28%) limbs. Over a wire crossing the iliac lesion, the covered stent was deployed, externalized through the femoral arteriotomy, and cut at the iliofemoral junction in such a way that no untreated transition zone remained between the stent and the open reconstruction of the femoral artery. Two elderly patients with critical limb ischemia died during the postoperative course, giving in-hospital mortality of 6.2%. Four (12.5%) presented with moderate to severe complications, including one transtibial amputation in a patient who presented with tissue loss at admission. The median follow-up period was 24.1 months (range: 0.8–64 months). One-year and two-year Kaplan-Meier estimates of overall survival were 91% (95% CI: 97–74) and 76% (95% CI: 89–53). One-year and two-year estimates of freedom from major amputation were 96% (95% CI: 99–76) and 91% (95% CI: 97–66). Estimates of primary patency, assisted primary patency, and secondary patency were: 93.7 (95% CI: 77.1–98.4) at 1 year, and 93.7 (95% CI: 77.1–98.4) at 2 years; 96.7% (95% CI: 78.6–99.6) at 1 year, and 96.7% (95% CI: 78.6–99.6) at 2 years; 96.7% (95% CI: 78.6–99.6) at 1 year and 96.7% (95% CI: 78.6–99.6) at 2 years, respectively. Our hybrid approach for iliofemoral lesions provided acceptable mortality and good mid-term patency rates. Further studies with long-term followup are needed to evaluate the safety and durability of this technique.