Hybrid First-Line Treatment Approach for Chronic Limb-Threatening Ischemia

Narrowed artery. Computer artwork of an artery that is partially blocked by an atheroma (yellow).
Investigators evaluated outcomes of a first-line hybrid approach in patients with chronic limb-threatening ischemia to determine possible predictors of loss of primary patency and limb clinical improvement.

At 36 months, the survival rate between groups was not statistically significant, even excluding early deaths. Improvement in RC was were statistically significantly higher in group 1 compared with group 2 (81% vs 47%).

Results of a binary logistic regression multivariate analysis showed that severe iliac artery stenosis (odds ratio [OR], 0.09) and the presence of preoperative patent leg vessels (OR, 8.03) were the only significant independent predictors of limb clinical improvement.

Study limitations include the retrospective, single-center nature of the research, the relatively small sample size, the limited follow-up period, as well as the inability to use amputation-free survival rate as a target variable due to the risk of overfitting.

“The use of a first line hybrid approach in patients with CLTI is a safe and feasible technique,” the researchers concluded. “From the analysis of the current study, it is clear that any effort should be made to achieve as many [patent] leg vessels as possible in order to obtain better and longer lasting clinical outcomes.”


Mezzetto L, Mastrorilli D, Scorsone L, et al. Early and midterm outcomes of hybrid first line treatment in patients with chronic limb threatening ischemia. Vascular. Published online August 20, 2021. doi:10.1177/17085381211040986