The application of hybrid technique in treating arterial embolism of limbs

Objective: To evaluate the clinical effect of the hybrid technique, i.e. arteriotomic thrombectomy together with endovascular therapy, in treating arterial embolism of limbs. Methods: During the period from June 2011 to June 2013 at authors' hospital, hybrid operation was carried out in 82 patients with arterial embolism of limbs. A total of 91 diseased limbs, including 8 upper limbs and 83 lower limbs, were treated. Arterial angiography of the extremity was routinely performed first, which was followed by catheterization. After the guild-wire passed through the clot a Fogarty catheter was inserted along the guild- wire, and under DSA monitoring embolectomy or balloon-assisted thrombectomy was performed. Based on the postoperative angiography findings, transcatheter thrombolysis, balloon angioplasty and/or stenting were employed. All the patients were followed up for 3-36 months. The improvement of limb ischemia and the limb salvage rate were analyzed. Results: Hybrid operation was successfully performed in all patients. The procedures included balloon-assisted embolectomy (n=6), transcatheter thrombolysis following embolectomy (n=24), balloon angioplasty following embolectomy (n=11) and stenting following embolectomy (n=4). Limb salvage rate was 83.5% (76/91), leaving dysfunction in 11 limbs. Complete recovery was obtained in 65 limbs (71.4%), and 7 patients died during perioperative period. During the follow-up period, the previously diseased arteries remained patent. Conclusion: For the treatment of limb arterial embolism, the hybrid operation has higher limb salvage rate and cure rate. (authors)