Hybrid procedures and distal origin grafts.

Endovascular techniques for treatment of infrainguinal arterial occlusive disease continue to dominate care for most symptomatic vascular patients. Diabetic patients with gangrene represent a subset of patients who can benefit from a combination of open and percutaneous techniques because of the multilevel nature of the disease. Most commonly, these involve surgical treatment of the infrageniculate disease with a distal origin bypass coupled with endovascular treatment of the ipsilateral superficial femoral artery. These approaches allow care to be delivered in a single setting, avoiding issues of staged procedures. Although published results from hybrid treatment are limited, the obvious patient benefit ensures that these techniques will continue to be important for vascular patient care.