الفهرس 
Acknowledgement
Epidemiology of Peripheral arterial diseaseOnly 14 pages are availabe for public view
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Abstract
Our results show that CFA endarterectomy in combination with inflow or outflow endovascular procedures can simplify the management of multilevel PAD in this group of high-risk patients, as each region can be treated with an approach that will best optimize outcomes and ensure safety for the patient as a whole.
Our series included thirty patients presenting with Stage III and IV Fontaine / Rutherford categories 4, 5 and 6.These patients underwent hybrid procedures for treatment of CLI at Vascular Surgery Department, Assuit University Hospital, Egypt.
There were 25/30 (83.3%) males and 5/30 (16.7%) females with a mean age of 65 years. The most frequent risk factor was smoking in 18/30 (60%), followed by diabetes in 16/30 (53.3%), hypertension in 14/30 (46.7%), dyslipidemia in 12/30 (40%), coronary artery disease in 9/30 (30%), and history of stroke in 3/30 (10%).
According to Rutherford classification, the majority of patients (50%) were treated for digital gangrene, followed by minor tissue loss (33.3%) and rest pain (16.7%).
The CFA was involved with atherosclerosis in all cases. It was associated with inflow disease in 8 cases (26.7%), with outflow disease in 8 cases (26.7%), and associated with both inflow and outflow disease in 14 cases (46.6 %).
Femoral endarterectomy was done in all cases, combined with both proximal and distal endoluminal procedures in 40% of patients, with proximal endoluminal procedures only in 26.7 % and with distal endoluminal procedures in 26.7%.One femorofemoral bypass and one iliofemoral bypass were combined.
Technical success was achieved in 95.8% of procedures with 100% hemodynamic and clinical success.
Only 4 cases had postoperative complications that were managed successfully,yielding a complication rate of 13.3%.
The primary patency rate at 1st, 6th and 12th months were 96.7%, 90% and 80% respectively. Secondary patency rates at 1st, 6th and 12th months were 100 %, 83.3% and 67% respectively while limb-salvage rate at 1st, 6th and 12th months were 100%, 100 %, and 93.3% respectively.
Among the different associated risk factors analyzed, Diabetes Mellitus is the only factor that affects the primary patency rate. Diabetes Mellitus has been found to reduce 1- year patency rate with statistically significant difference (P – value < 0.05).
The 1-year patency rate was higher when vascular stents were placed than among non-stented arteries with statistically significant difference (P – value = 0.03), but it was lower in combined inflow & outflow lesions than among inflow only or outflow only with statistically significant difference ( P- value = 0.01).