الفهرس 
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Abstract
Our results showed that hybrid management in ALI yielded better outcomes than either thrombectomy or endovascular therapy alone especially in cases of acute thrombotic ALI with underlying diseased leg vessels that were managed accordingly to ensure patency and safety of the patient`s life as a whole.
Our study included a hundred patients (100 limbs) who suffered from ALI either of thrombotic or embolic origin. These patients underwent the hybrid revascularization procedure at the Vascular and Endovascular Surgery Department, Assiut University Hospitals, Egypt.
The study included 78 males and 22 females with a mean age of 65±10 years. Smoking was the most frequent risk factor with 69% prevalence, followed by diabetes in 68% of patients. Other risk factors were hypertension, CAD, atrial fibrillation, dyslipidemia and prior CVS.
According to Rutherford`s classification, patients presented with grade I in 31%, grade IIa in 37% and grade IIb occurred in 32% of the study patients.
All surgical procedures started with femoral thrombo-embolectomy. Simple embolectomy alone was done in 18 patients (18%), while 82 patients (82%) required hybrid procedures to treat the underlying culprit lesions.
After arteriotomy closure, intra-operative diagnostic angiography was done in all cases and showed complete in-line flow to the foot in 18 patients with no further intervention while the remaining 82 patients required PTA of culprit lesions.
The endovascular approach in the hybrid procedures started with PTA of the culprit arterial lesions and then followed by completion angiography that showed complete in line flow to the foot in 65 patients and no further intervention was required. Ten patients of the remaining 17 patients, have showed flow-limiting dissection and were successfully treated with SFA stenting while the other seven patients showed thrombosis of the distal leg vessels and received a trial of on-table lysis. On-table lysis showed a complete resolution of the residual thrombus in five patients while the remaining two patients failed to respond the lysis treatment and received fasciotomy.
Immediate clinical and technical success was obtained in 98% and 95% of patients, respectively. Postoperative complications occurred in 16 patients and were managed accordingly.
Primary patency rate was 91% and 86% at six months and 1 year, respectively while the secondary patency rate was 85% and 79% at six months and 1 year respectively. Limb salvage rate was 93% in one year
Cox regression and multivariate analysis were used to analyze the different risk factors attributing to loss of patency at one year and showed that smoking, diabetes, and thrombotic ALI significantly affect the one-year patency rate.
Hybrid revascularization provides an effective and safe treatment option for patients presenting with ALI of the lower extremity particularly those with acute-on-chronic or subacute arterial thrombosis. Smoking, diabetes, and thrombotic occlusion were associated with increased risk for loss of patency after successful revascularization of ALI.