الفهرس 
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Abstract
Objective: To evaluate our preliminary experience and early results of a combined endovascular procedure and open arterial reconstruction in multilevel atherosclerotic occlusive disease. Patients and methods: From April 2002 to October 2004 combined angioplasty and/or stenting and open arterial reconstruction weather staged or simultaneous were performed on 21 limbs of 21 patients. The indication for the procedure was critical limb ischemia (16 patients), disabling claudication (3 patients) or acute presentation on top of chronic limb ischemia (2 patients). Results: The endovascular procedure was done on either: aorto-iliac segment (15 patients), femoro-popliteal segment (4 patients), aortoiliac and femoro-popliteal segments (1 patient) or femoropopliteal and tibio-peroneal segments (1 patient). The endovascular approach was: balloon angioplasty (13 patients), balloon mounted stent (5 patients) or self expandable stent (3 patients). The endovascular procedure was done on 17 cases classified as Tasc type A lesion, 2 cases classified as Tasc type B lesion, one case both Tasc A & B and one case both Tasc B & C. The endovascular procedure was simultaneous in 13 cases with the open procedure whereas in 8 cases were staged. The open arterial reconstruction was: either end-arterectomy, thrombectomy, femorofemoral bypass, femoro-popliteal bypass, femoro-anterior-tibial bypass or aorto-bi-femoral bypass. The follow-up period ranged from 2 - 32 months with mean 17 months. There were 3 failure of the open procedure namely femoropopliteal and only in one there was also failure of the iliac angioplasty occurred at 2, 5 and 7 months respectively. We report cumulative patency of 81.2% at 12 months follow up for the open procedure, 92.6% for the endovascular procedure and 83.05% for the combined procedure and at the same time interval. Conclusions: The combined approach of endovascular procedure and open arterial reconstruction can be performed in a satisfactory manner for multilevel atherosclerotic occlusive disease by the vascular surgeon either simultaneously using a portable C arm fluoroscopy in the operating room or staged weather in the operating room or in the angiography suite.