الفهرس 
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Abstract
Multilevel arterial occlusive disease in patients with chronic limb threatening ischemia (CLTI) represent a major revascularisation challenge to vascular surgeons. The goal of treatment is a single intervention procedure that results in an excellent technical success without associated complications or the need for further interventions. The current Prospective case series study including (30) patients complaining of chronic lower limb threatened ischemia (rest pain or tissue loss) all of them have CFA lesion (tight stenosis ≥50% or total occlusion) with proximal (iliac)or distal (femoropopliteal or tibial) lesions. The aim of the study is to assess the outcomes of common femoral endarterectomy combined with an inflow or outflow endovascular revascularization procedure as an alternative for high risk patients with CLTI. CFA Endarterectomy was performed in all cases in the current cohort with EVT of separate iliac lesion in 10% outflow lesion in 63% of cases (SFA 33% and tibial 30%) and combined iliac and SFA revascularization in 27% of patients. Every patient will have visits every week till first month, then every 3 months till 2 years. Technical success was achieved in 100% of the procedures. The intraoperative complication rate was (6.66%): in two patients the first intraoperative angiography showed a dissection of the SFA, and another patient underwent thromboembolectomy due to an intraoperative peripheral embolization detected by the first angiography. Hemodynamic success was achieved in 29 patients (96%). The median ABI improved significantly, rising from 0.3(0.2-0.4) preoperatively to 0.7(0.4-0.9) postoperatively. Clinical success was achieved in 29 patients (96%). As procedures resulted in an improvement in clinical status with 26.5% (8/30) having grade 3 improvement, 56.5% (17/30) grade 2, and 13.5% (4/30) grade 1, according to the AHA classification. Only one patient had no improvement (grade 0). We reported patency of CFA 100% at 3, 6 months and 96% at 9, 12, 18 months and 88% at 24 months in which only one patient had CFA re-occlusion at 9 months follow up and another one at 21 month follow up managed conservatively as they had no symptoms Regarding the limb salvage we had only one patient who underwent BKA at 10 months and we achieved limb salvage 100% at 3, 6 months and 96 % at 9, 12, 18, 24 months. In conclusion, we corroborate the concept that CFE should remain the treatment of first choice of CFA occlusive disease as it is safe, effective, and durable procedure for common femoral artery disease, and the simultaneous hybrid CFA endarterectomy and endovascular therapy for multilevel occlusive artery disease can provide an immediate satisfactory results, durable midterm patency, and also less invasive therapeutic option in high-risk patients.