Using a Hybrid Approach to Treat Chronic Limb-Threatening Ischemia

Chronic limb-threatening ischemia is a major public health concern, given its association with increased mor tality, risk of amputation, and impaired quality of life. The arterial lesions are often extensive, reaching several levels and making revascularization complex. Hybrid treatment, which combines the advantages of open surgery and endovascular
therapy, may be helpful. We present the case of a 74-year-old man with a history of myocardial infarction, stage 3 chronic kidney disease, arterial hypertension, dyslipidemia, and diabetes. Nine years earlier, he had a femoropopliteal bypass; 7 years earlier, a femorotibial bypass and transmetatarsal amputation; and 2 years earlier, a new femorotibial bypass with ligation of the superficial femoral artery ostium. He developed a gangrenous foot stump (Rutherford classification stage 5) following a subacute thrombosis of his last femorotibial bypass. We performed retrograde transluminal femoropopliteal recanalization and a short prosthetic bypass between the common femoral artery and the proximal part of the superficial femoral artery. Six months later, the foot stump was healed. In conclusion, hybrid treatment may be helpful to revascularize limbs with multilevel complex occlusive arterial disease. When open surgery is realized, it is mandatory to avoid any arterial ligation to keep potential future percutaneous treatment possible.