الفهرس 
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Abstract
Our results show that CFA endarterectomy or bypass surgery in combination with inflow or outflow endovascular procedures can simplify the management of multilevel PAD in this group of high risk patients , as each lesion in different patho-anatomical configuration can be treated with an approach that will best optimize outcomes and ensure saftey for the patients as a whole .
This series included twenty patients presented with crritical lower limb ischemia . Those patients underwent hybrid procedure for treatment of CLI at Vascular Surgery unit- Minia university.
There were 17/20 (85%) males and 3/20(15%) females with mean age 67.35 years. The most frequent risk factor was diabetes in 15/20(75%) followed by HTN and smoking 13/20(65%) with IHD in 9/20 (45%) and cerebro vascular strokes in 3/20(15%)
According to Rutherford classification , the majority was in category 5 with minor tissue loss 11/20(55%) , followed by category 6 with major tissue loss 5/20(25%) and category 4 with rest pain only without tissue loss 4/20(20%).
The CFA bifurcation and outflow lesions were involved with in all cases (20 cases ) . In only 6 cases , inflow lesions were reported (30%) .
Femoral endarterectomy was performed in all 20 cases and combined with patch closure in 14/20(70%) of cases , with femoro-popliteal bypass in 4/20 cases (20%) and with femoro- femoral bypass in 2/20 cases (10%).
Endoluminal procedures were done for inflow lesions in 4cases (20%) and outflow endoluminal preocedure in all cases .
Technical success was achieved in 90% of patients with 90% clinical success and limb salvage .
7 cases out of 20 had postoperative complcations . 5 of them were treated successfully , while 2 of them underwent below knee amputation (10% of studied cases) .