{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:05:10Z","timestamp":1780499110142,"version":"3.54.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T00:00:00Z","timestamp":1645401600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>Purpose: We present a hybrid technique for the treatment of chronic limb-threatening ischemia (CLTI) due to complex, multilevel infrainguinal disease. It consists of an open distal endarterectomy combined with endovascular proximal treatment (the DEEP technique). Materials and Methods: This was a prospective cohort study. Thirty-three limbs (30 patients) were treated. Main inclusion criteria were absence of significant disease in femoral bifurcation associated with a complex infrainguinal pattern. This approach was specially considered in absence of suitable vein for bypass, obesity, hostile groin, and overall high surgical risk. Results: Mean age was 72.8 \u00b1 10 years (ranging 50\u201393). Most cases presented with severe limb threatening onset (90.9% Rutherford &gt;4 and 81.8% WIfi &gt;3) due to high-complexity infrainguinal disease pattern (Global Limb Anatomic Staging System [GLASS] stage III) in 31\/33 (93.9%), chronic total occlusions (CTOs) in 24\/33 (72.7%), and severe calcification (Peripheral Arterial Calcium Scoring System [PACSS] grade 4) in 22\/33 (66.6%). Mean lesion length was 228.2 mm \u00b1 83 (ranging 40\u2013340 mm). In all procedures, a covered-stent (25 cm length Viabahn) was implanted in a retrograde fashion as the endovascular component. Effective revascularization was achieved in all cases, showing significant clinical and hemodynamic improvement (median pre- and postprocedure ankle-brachial index [ABI]: 0.3 and 0.9, respectively). Results at 12 months follow-up were as follows: 93.9% limb salvage ratio, 75.7% primary patency, 84.6% assisted primary patency, and 90.9% secondary patency. Major adverse limb events (MALE) and cardiovascular events (MACE) occurred in 8\/33 (24.2%) and 2\/33 (6%), respectively. Mean length of postoperative stay was 7.5 \u00b1 6.92 days (3\u201327). Conclusion: This less invasive hybrid technique has promising short-term results for limb salvage and it is worth to be included in vascular armamentarium for CLTI revascularization in selected patients.<\/jats:p>","DOI":"10.1177\/15266028221079766","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T03:44:12Z","timestamp":1645415052000},"page":"232-240","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Distal Endarterectomy Combined With Endovascular Proximal Treatment: The Hybrid DEEP Retrograde Technique for High-Complexity Infrainguinal Disease"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0010-6345","authenticated-orcid":false,"given":"Luis J","family":"Garc\u00eda Dom\u00ednguez","sequence":"first","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario y Polit\u00e9cnico la Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Ramos Moreno","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario y Polit\u00e9cnico la Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7044-258X","authenticated-orcid":false,"given":"Rafael","family":"Martinez L\u00f3pez","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario y Polit\u00e9cnico la Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Rib\u00e9 Bernal","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Hospital Universitario y Polit\u00e9cnico la Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Hern\u00e1ndez Sanfelix","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Vascular Diagnostic Laboratory, Hospital Universitario y Polit\u00e9cnico la Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8340-8172","authenticated-orcid":false,"given":"Manuel","family":"Miralles Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Head of Vascular Surgery Department, Hospital Universitario y Polit\u00e9cnico la Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,2,21]]},"reference":[{"key":"bibr1-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.02.016"},{"key":"bibr2-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.07.038"},{"key":"bibr3-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2017.09.008"},{"key":"bibr4-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.01.066"},{"key":"bibr5-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.05.244"},{"key":"bibr6-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.06.042"},{"key":"bibr7-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.05.102"},{"key":"bibr8-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2015.09.004"},{"key":"bibr9-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2021.04.017"},{"key":"bibr10-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.11.041"},{"key":"bibr11-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1177\/1526602816656612"},{"key":"bibr12-15266028221079766","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.08.003"},{"issue":"64","key":"bibr13-15266028221079766","first-page":"e1","volume":"2016","author":"Stoner 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