title: Hybrid vascular surgery approaches for multilevel arterial occlusive disease.
abstract: BACKGROUND
  The incidence of multilevel vascular occlusive disease is increased with patient age. Multilevel arterial occlusive disease cases are some of the hardest in the vascular surgical realm because of the comorbidities. In these high-risk patients inflow constrictions may limit the success of distal bypasses. At the same time the constrictions in the outflow may necessitate long bypass circuits that have less long-term patency rates.
  
  
  METHODS
  Our study included 38 patients with multilevel arterial occlusive disease to whom hybrid vascular approaches were applied between January 2005 and December 2011 in Şişli Florence Nightingale Hospital. The patient group had a mean age of 68.1 (48-98) and included 29 male (89%) and 9 female (11%) patients. Complaints were claudication under 100 meters of walking in 19 patients (50%), resting pain in 14 patients (36%), and disturbed tissue integrity in 5 patients (14%). Mean in-hospital stay was calculated to be 6.4 days (4-15). In one patient (2.6%), a second procedure was necessary due to graft thrombosis and this case resulted in amputation under the level of the knee. Minor toe amputations in a second session were applied to 5 patients (14%) with symptoms of foot sores. Wound infections occurred in two patients (5%) and were treated with antibiotherapy and wound care.
  
  
  RESULTS
  At the end of the follow-up time, extremity survival was found to be 94.1%.
  
  
  CONCLUSIONS
  In the treatment of multilevel peripheral arterial occlusive disease, a hybrid approach is a treatment option which is less invasive and sufficient.
authors.affiliation: Department of Cardiovascular Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. Email:keremoral@gmail.com.
authors.forename: Kerem
authors.initials: K
authors.lastname: Oral
authors.affiliation: Department of Cardiovascular Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. Email:keremoral@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ezelsoy
authors.affiliation: Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Ayalp
authors.affiliation: Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Kayabali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*