The 9th Japan-Korea Joint Meeting for Vascular Surgery.

Introduction Peripheral arterial occlusive disease is commonly presented as a fashion of multilevel occlusive disease, especially in patients with critical limb ischemia. 1) In these patients with multilevel arterial disease usually requires complex arterial reconstructions , in order to provide patients with adequate clinical improvement. The term " hybrid'' means the use of combined open surgical and endovascular procedures simultaneously and the number of procedures are now increasing with the percentage of 5 to 21% of current limb revascularization procedures. Conventional open surgical procedures is the gold standard for treatment of extensive occlusive disease. However open surgical procedures of such lesions consisted of extensive and time-consuming procedures. Also, patients with multilevel arterial disease are usually aged patients and frequently associated with significant comorbidities and critical limb ischemia, 4) categorizing these patients as high risk for major operative procedures. So, hybrid repair has obvious appeal in these patients with less surgical morbidity, decreased hospital stay, and patient preference dictating a minimally invasive approach. In regarding to endovascular surgery, iliac artery angioplasty with or without stenting is well recognized and increasing procedures for the patient with localized iliac or femoropopliteal disease even in TASC C/D lesions, however, such endovascular procedures have some limitations when the disease is extended to common femo-ral artery or long segment femoropopliteal occlusive disease. In hybrid procedures, endarterectomy of common femoral artery (CFA) with extension to distal external iliac artery (EIA) or superficial femoral artery (SFA) is a key component of procedures and it can be an ideal place for the introduction of endo-vascular procedure or distal bypass surgery. So, treatment of CFA with a surgical component of hybrid repair may enhance the technical success or late results in comparison to sole endo-vascular treatment. In this article, we introduce the current use of common hybrid revascularization in our hospital. Iliac Artery Stenting and Common Femoral Endarterectomy The most common procedures of hybrid surgery in the litera-tures are iliac artery stenting and common femoral endarterectomy, and many investigators think the hybrid procedure is ideal for these patient. 3–5) After exposure of the common, superficial, and deep femoral artery, the CFA is opened via a longitudinal arteriot-omy, and endarterectomy is performed to remove the obstructing plaque. The arteriotomy can be extended proximally to distal EIA or distally to proximal SFA according to the extent of disease. Reconstruction of the CFA is typically completed using a patch (autogenous saphenous vein, synthetic …