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J Vasc Surg. 2018 Nov;68(5):1447-1454.e5. doi: 10.1016/j.jvs.2018.01.058.

Hybrid femoropopliteal procedures are associated with improved perioperative outcomes compared with bypass.

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Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
Yale School of Public Health, New Haven, Conn.
Section of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn. Electronic address:



Hybrid procedures have gained momentum as less invasive operations that can potentially improve outcomes for patients. However, there is a paucity of data comparing hybrid procedures with traditional bypass. This study compares the perioperative outcomes of hybrid and bypass surgery for femoropopliteal (FP) revascularization.


The American College of Surgeons National Surgical Quality Improvement Program files (2012-2015) were reviewed, and three groups of patients undergoing isolated FP revascularization were identified by Current Procedural Terminology codes. All patients underwent femoral endarterectomy. The hybrid group (HYB) had a concomitant antegrade endovascular FP intervention and was compared with patients with concomitant FP bypass with vein (BPV) and FP bypass with nonvein graft (BPG). The demographics, comorbidities, and outcomes of the three groups were analyzed. The χ2 and analysis of variance tests with post hoc analysis were used. A multivariable logistic regression analysis was performed to identify predictors of readmission, reoperation, and mortality.


There were 1480 patients in the analysis. Compared with patients undergoing BPV and BPG, patients in the HYB group tended to be older (P = .016) and were less likely to be smokers (P < .001). They had fewer infected wounds (P = .001) and were more likely to have American Society of Anesthesiologists score ≤3 (P = .01) and claudication (P < .01). HYB patients had significantly fewer bleeding transfusions (P = .01) and less overall morbidity (P < .001) compared with BPV and BPG patients. The three treatment groups did not differ in frequencies of mortality and major amputation. Among the groups, BPV was associated with the longest operating time (P < .001), whereas HYB had significantly shorter hospital stay (P < .001). HYB was also associated with significantly lower rates of reoperation (P = .017) and readmission (P = .007). On multivariable regression, patients undergoing BPG were at increased risk of readmission (odds ratio [OR], 1.48 [1.00-2.17]) compared with HYB. HYB surgery was associated with less morbidity compared with BPV (OR, 1.38 [1-1.9]) and BPG (OR, 1.77 [1.3-2.38]).


Hybrid procedures have favorable perioperative outcomes compared with open bypass for FP revascularization. Additional research on the long-term outcomes of hybrid procedures is needed.


Femoropopliteal bypass; Femoropopliteal disease; Hybrid surgery; Peripheral arterial disease


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