Hybrid Therapy for Lower Extremity Acute Arterial Occlusion

Purpose: A lower extremity acute arterial occlusion (LEAAO) is observed to be complicated lesion such as multiple stenosis, occlusion and severe calcification. It is difficult to make a strategy decision. We report hybrid therapy for four cases of LEAAO.
Cases: Case 1: A 63-year-old male. He has a pain, coldness and cyanosis in his right leg suddenly. Emergency CT angiogram revealed total occlusion of external iliac artery (EIA) and popliteal artery (POP) in his right leg. Case2: A 90-year-old female. She has a pain and coldness in her left leg suddenly. Emergency CT angiogram revealed total occlusion of superficial femoral artery (SFA) in her left leg. Case3: A 65-year-old male. He has a pain and cyanosis in his left leg suddenly. Emergency CT angiogram revealed total occlusion from EIA to POP in his left leg. Case4: A 74-year-old male. He has a pain in his left leg suddenly. Emergency CT angiogram revealed total occlusion from EIA to SFA in his left leg.
Strategy and treatment: A one- stage hybrid therapy was selected and performed by surgeons and cardiologists in all cases. Case1: After a thromboendarterectomy (TEA) using a fogaty catheter for POP was performed by surgeons, percutaneous peripheral intervention (PPI) was performed for EIA by cardiologists.Case2: After a TEA using a fogaty catheter from EIA to POP was performed by surgeons, PPI was performed for POP by cardiologists.
Case3: After a TEA using a fogaty catheter from SFA to POP was performed by surgeons, PPI was performed for SFA by cardiologists. Case4: After a TEA using a fogaty catheter for EIA and profunda femoris artery (PFA) was performed by surgeons, PPI was performed for EIA by cardiologists. In all cases, a one-stage hybrid therapy was successfully performed.
Conclusion: A one-stage hybrid therapy by a vascular team was an effective and a safe strategy for a lower extremity acute arterial occlusion with multiple complications.