Hybrid procedures as a novel technique in the treatment of critical limb ischemia.

In hybrid reconstructions, patients are treated using both endovascular and open revascularization techniques simultaneously. In recent years, these multilevel reconstructions have been increasingly used especially by vascular surgeons as they have adopted new knowledge and endovascular skills and the endovascular techniques have evolved. The first reports of combined endovascular and open surgical procedures are from the 1970s. Since then, most reports have dealt with femoral endarterectomy or femoro-femoral bypass combined with inflow iliac percutaneous transluminal angioplasty (PTA) and stenting. Primary success rates have been high: 93%-100%. In our institution 213 hybrid procedures were performed during 2003-2011 with 98.6% technical success rate. The annual number of hybrid procedures ranged from 4 in 2004 to 73 in 2011. Inflow endovascular procedure was performed in 60% and outflow in 40 % of the cases. The proportion of the endovascular component performed by vascular surgeons increased from 0% in 2004 to 86.3% in 2011. In the current report we review the results published in the literature, report our own experience and present some technical notes and cases.