The study included patients with chronic critical limb ischemia according to the 2019 European Society for Vascular Surgery (ESVS) recommendations and TASK II, who underwent revascularization through open surgical intervention (femoropopliteal bypass, endarterectomy, thromboembolectomy) in 48 (33.1%) cases (Group I), endovascular intervention (angioplasty and stenting) in 73 (50.3%) cases (Group II), or hybrid surgical intervention in 24 (16.6%) cases (Group III) for occlusive-stenotic lesions of the femoropopliteal segment.
Chronic arterial insufficiency of Rutherford category 4 was observed in 80 observations (78.0±1.8%), and category 5-6 in 65 observations (62.0±2.2%).
There was a statistically significant difference in the presence of diabetes among patients between the groups (p<0.001). Diabetes was present in only 16.7% of observations in the open surgical intervention group, 45.8% in the endovascular intervention group, and 54.8% in the hybrid surgical intervention group.
Statistical analysis revealed a significant preference for endovascular intervention (p-value <0.001) in patients with diabetes (40 cases, 54.8%) and comorbid pathology (76 cases, 1.6%).
Limb preservation without amputation one year post-revascularization was achieved in 95.9% of observations in Group I, 94.5% in Group II, and 91.6% in Group III, respectively. The overall limb preservation rate for all types of operations at 1 year was 90.3%.
The analysis showed a significant difference in avoiding repeat surgical intervention between Group I (40 observations, 36.3±0.27) and Group II (54 observations, 51.3±0.37), compared to Group III (20 observations, 12.8±0.13). There was no statistically significant difference between the groups in the risk of limb amputation (p=0.473), but there was a statistically significant difference in the risk of requiring repeat surgery (p=0.389).
The results of this study suggest that hybrid surgery, combining both open surgical and endovascular methods, may be more advantageous in the long term for limb salvage without repeat surgical interventions, compared to open surgery and endovascular intervention, especially for significant femoropopliteal segment lesions. Additionally, open surgical intervention and endovascular intervention showed no differences in limb preservation and repeat surgical interventions in patients who retained their limbs for over 1 year after revascularization, with this strategy being associated with a significant increase in overall survival and a trend towards improved limb preservation and healing of trophic changes in the lower limb.
In the analysis of cost-effectiveness, the calculation of the economic efficiency coefficient (profitability) for the open surgical method was almost 1.7 times lower than for the endovascular method and hybrid surgical intervention. The calculations showed that the economic efficiency coefficient (profitability) for open surgical intervention was more than 1.5 times lower than for endovascular intervention and 1.9 times lower compared to hybrid surgical intervention. The efficiency index for all types of operations was 0.97 for open surgical intervention, 0.94 for endovascular intervention, and 0.91 for hybrid surgical intervention, respectively.
